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Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Quantitative Real-Time PCR Assays To Identify and Quantify Fecal Bifidobacterium Species in Infants Receiving a Prebiotic Infant Formula

ABSTRACT A healthy intestinal microbiota is considered to be important for priming of the infants ' mucosal and systemic immunity . Breast-fed infants typically have an intestinal microbiota dominated by different Bifidobacterium species . It has been described that allergic infants have different levels of specific Bifidobacterium species than healthy infants . For the accurate quantification of Bifidobacterium adolescentis , Bifidobacterium angulatum , Bifidobacterium bifidum , Bifidobacterium breve , Bifidobacterium catenulatum , Bifidobacterium dentium , Bifidobacterium infantis , and Bifidobacterium longum in fecal sample s , duplex 5′ nuclease assays were developed . The assays , targeting rRNA gene intergenic spacer regions , were vali date d and compared with conventional PCR and fluorescent in situ hybridization methods . The 5′ nuclease assays were subsequently used to determine the relative amounts of different Bifidobacterium species in fecal sample s from infants receiving a st and ard formula or a st and ard formula supplemented with galacto- and fructo-oligosaccharides ( OSF ) . A breast-fed group was studied in parallel as a reference . The results showed a significant increase in the total amount of fecal bifidobacteria ( 54.8 % ± 9.8 % to 73.4 % ± 4.0 % ) in infants receiving the prebiotic formula ( OSF ) , with a diversity of Bifidobacterium species similar to breast-fed infants . The intestinal microbiota of infants who received a st and ard formula seems to resemble a more adult-like distribution of bifidobacteria and contains relatively more B. catenulatum and B. adolescentis ( 2.71 % ± 1.92 % and 8.11 % ± 4.12 % , respectively , versus 0.15 % ± 0.11 % and 1.38 % ± 0.98 % for the OSF group ) . In conclusion , the specific prebiotic infant formula used induces a fecal microbiota that closely resembles the microbiota of breast-fed infants also at the level of the different Bifidobacterium species

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The effect of enteral supplementation of a prebiotic mixture of non-human milk galacto-, fructo- and acidic oligosaccharides on intestinal permeability in preterm infants.

Preterm infants have an impaired gut barrier function . We aim ed to determine the effects of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides ( short-chain galacto-oligosaccharides (SCGOS)/long-chain fructo-oligosaccharides ( LCFOS ) ) and acidic oligosaccharides ( AOS ) on intestinal permeability of preterm infants as measured by the sugar absorption test in the first week of life . Furthermore , we determined host- and treatment-related factors associated with intestinal permeability . In a r and omised controlled trial , preterm infants with a gestational age < 32 weeks and /or birth weight ( BW ) < 1500 g received enteral supplementation of SCGOS/LCFOS/AOS or placebo ( maltodextrin ) between days 3 and 30 of life . Intestinal permeability , reflected by the urinary lactulose/mannitol ( L/M ) ratio after oral ingestion of lactulose and mannitol , was assessed at three time points : before the start of the study ( t = 0 ) , at day 4 ( t = 1 ) and at day 7 ( t = 2 ) of life . Data were analysed by generalised estimating equations . In total , 113 infants were included . Baseline patient and nutritional characteristics were not different between the SCGOS/LCFOS/AOS ( n 55 ) and the placebo groups ( n 58 ) . SCGOS/LCFOS/AOS had no effect on the L/M ratio between t = 0 and t = 2 . In both the groups , the L/M ratio decreased from t = 0 to t = 2 ( P < 0·001 ) . Low BW increased the L/M ratio ( P = 0·002 ) . Exclusive breast milk feeding and mixed breast milk/formula feeding during the first week of life decreased the L/M ratio ( P < 0·001 and P < 0·05 , respectively ) . In conclusion , enteral supplementation of a prebiotic mixture does not enhance the postnatal decrease in intestinal permeability in preterm infants in the first week of life

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Effects of galactooligosaccharide and long-chain fructooligosaccharide supplementation during pregnancy on maternal and neonatal microbiota and immunity--a randomized, double-blind, placebo-controlled study.

BACKGROUND Galactooligosaccharides ( GOS ) and long-chain fructooligosaccharides ( lcFOS ) proliferate bifidobacteria in infant gut microbiota . However , it is not known how GOS and FOS influence the microbiota of pregnant women and whether a potential prebiotic effect is transferred to the offspring . OBJECTIVES We aim ed to test how supplementation with GOS and lcFOS ( GOS/lcFOS ) in the last trimester of pregnancy affects maternal and neonatal gut microbiota . Variables of fetal immunity were assessed as a secondary outcome . DESIGN In a r and omized , double-blind , placebo-controlled pilot study , 48 pregnant women were supplemented 3 times/d with 3 g GOS/lcFOS ( at a ratio of 9:1 ) or maltodextrin ( placebo ) from week 25 of gestation until delivery . Percentages of bifidobacteria and lactobacilli within total bacterial counts were detected by fluorescent in situ hybridization and quantitative polymerase chain reaction in maternal and neonatal ( days 5 , 20 , and approximately 182 ) stool sample s. Variables of fetal immunity were assessed in cord blood by using flow cytometry and cytokine multiplex-array analysis . RESULTS The proportions of bifidobacteria in the maternal gut were significantly higher in the supplemented group than in the placebo group ( 21.0 % and 12.4 % , respectively ; P = 0.026 ) ; the proportion of lactobacilli did not differ between the groups . In neonates , bifidobacteria and lactobacilli percentages , diversity and similarity indexes , and fetal immune parameters did not differ significantly between the 2 groups . Mother-neonate similarity indexes of bifidobacteria decreased over time . CONCLUSIONS GOS/lcFOS supplementation has a bifidogenic effect on maternal gut microbiota that is not transferred to neonates . The increased maternal bifidobacteria did not affect fetal immunity as measured by a comprehensive examination of cord blood immunity variables

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The capacity of nondigestible carbohydrates to stimulate fecal bifidobacteria in healthy humans: a double-blind, randomized, placebo-controlled, parallel-group, dose-response relation study.

BACKGROUND Nondigestible carbohydrates ( NDCHs ) are fermented in the colon , where they can selectively promote the growth of bifidobacteria . OBJECTIVE Our aim was to determine the bifidogenic potential of different NDCHs used in human diets . DESIGN Two hundred healthy volunteers participated in this double-blind study . During phase 1 ( screening ) , 64 volunteers were r and omly assigned to 8 groups of 8 subjects each ; for 7 d , they ingested 10 g/d of 1 of the 7 NDCHs tested or of the placebo . During phase 2 ( dose-response study ) , 136 volunteers were r and omly assigned to 4 groups of 32 subjects who received 2.5 , 5.0 , 7.5 , or 10 g/d , respectively ( 8 subjects/dose ) , of one of the NDCHs that were proven to be bifidogenic during phase 1 and a fifth group of 8 subjects ( control subjects ) who received the placebo . Stools were recovered before and after NDCH consumption . RESULTS In phase 1 , 4 NDCHs were found to be bifidogenic : short-chain fructooligosaccharides ( P=0.008 ) , soybean oligosaccharides ( P=0.006 ) , galactooligosaccharides ( P < 0.0001 ) , and type III resistant starch ( P=0.02 ) ; lactulose , long-chain inulin , and isomaltooligosaccharides were not bifidogenic . In phase 2 , the effects of 7-d treatment on bifidobacteria concentrations were found to differ significantly among the 4 NDCHs ( P=0.009 for time x treatment interaction ) . However , no significant differences were found among doses , and there was no significant dose x time interaction . A low baseline bifidobacteria count was significantly associated with the bifidogenic response to treatment ( P < 0.001 ) . CONCLUSION This study showed the different bifidogenic properties among the substrates and underlined the importance of taking into account the baseline bifidobacteria counts when evaluating the effect of the treatment

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Neutral and acidic oligosaccharides in preterm infants: a randomized, double-blind, placebo-controlled trial.

BACKGROUND Serious infectious morbidity is high in preterm infants . Enteral supplementation of prebiotics may reduce the incidence of serious infections , especially infections related to the gastrointestinal tract . OBJECTIVE The objective was to determine the effect of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides ( (SC)GOS/(LC)FOS ) and acidic oligosaccharides ( AOS ) on serious infectious morbidity in preterm infants . DESIGN In a r and omized controlled trial , preterm infants ( gestational age < 32 wk and /or birth weight < 1500 g ) received enteral supplementation of 80 % (SC)GOS/(LC)FOS and 20 % AOS ( 1.5 g . kg(-1 ) . d(-1 ) ) or placebo ( maltodextrin ) between days 3 and 30 of life . Serious infectious morbidity was defined as a culture positive for sepsis , meningitis , pyelonephritis , or pneumonia . The analysis was performed by intention-to-treat and per- protocol , defined as > or = 50 % supplementation dose during the study period . RESULTS In total , 113 preterm infants were included . Baseline and nutritional characteristics were not different between groups . In the intention-to-treat analysis , the incidence of > or = 1 serious infection , > or = 1 serious endogenous infection , or > or = 2 serious infectious episodes was not significantly different in the (SC)GOS/(LC)FOS/AOS-supplemented and placebo groups . In the per- protocol analysis , there was a trend toward a lower incidence of > or = 1 serious endogenous infection and > or = 2 serious infectious episodes in the (SC)GOS/(LC)FOS/AOS-supplemented group than in the placebo group ( P = 0.09 and P = 0.07 , respectively ) . CONCLUSIONS Enteral supplementation of (SC)GOS/(LC)FOS/AOS does not significantly reduce the risk of serious infectious morbidity in preterm infants . However , there was a trend toward a lower incidence of serious infectious morbidity , especially for infections with endogenous bacteria . This finding suggests a possible beneficial effect that should be evaluated in a larger study . This trial was registered at is rct n.org as IS RCT N16211826

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Motilin and gastrin secretion and lipid profile in preterm neonates following prebiotics supplementation: a double-blind randomized controlled study.

BACKGROUND Gut hormones play an important role in the adaptation of the immature neonatal gut , and their secretion may be modulated by prebiotics . Furthermore , prebiotics are well known for their hypolipidemic potentials . We tested the hypothesis that prebiotics could alter motilin and gastrin secretion and reduce lipids in healthy preterms . METHODS A total of 167 newborns were r and omized to either a prebiotics enriched formula containing dietary oligosaccharides ( short-chain galacto-oligo-saccharides/long-chain fructo-oligo-saccharides [ scGOS/lcFOS ] ) , at a concentration of 0.8 g/100 ml , or a common preterm formula . Day 1 and 16 basal motilin , gastrin concentrations , and lipids were evaluated together with growth parameters , gastric residue , bowel habits , and feeding tolerance . Adverse events including necrotizing enterocolitis ( NEC ) and septicemia were also recorded . RESULTS Mean motilin increase and day 16 mean values were greater for the intervention , compared with the control group ( P = .001 , P = .005 , respectively ) , while gastrin remained high in both groups . Mean cholesterol and low density lipoprotein ( LDL ) increase were significantly greater in the control , compared with the intervention ( P = .037 , and P = .001 ) group . Day 16 LDL levels were significantly higher in the control group . Mean weight was increased in the control group , while gastric residue was less and stool frequency was increased in the intervention group . NEC and septicemia were not statistically different between groups . CONCLUSION A prebiotics enriched formula result ed in significant surge of motilin relating to reduced gastric residue , compared with a common preterm formula . Mean cholesterol change was lower , while LDL was not increased in the prebiotics group , compared with the control group

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Dosage-Related Bifidogenic Effects of Galacto- and Fructooligosaccharides in Formula-Fed Term Infants

Background Human milk oligosaccharides have been shown to stimulate selectively the growth of Bifidobacteria and Lactobacilli in the intestine . In this study , the bifidogenic effect of an experimental prebiotic oligosaccharide mixture consisting of low-molecular-weight galactooligosaccharides and high-molecular-weight fructooligosaccharides was analyzed in 90 term infants . Methods Two test formulas were supplemented with either 0.4 g/dL or with 0.8 g/dL oligosaccharides . In the control formula , maltodextrin was used as placebo . At study day 1 and study day 28 , the fecal species , colony forming units ( cfu ) and pH were measured and stool characteristics , growth , and side effects were recorded . Results At study day 1 , the median number of Bifidobacteria did not differ among the groups ( 0.4 g/dL group , mean [ interquartile range ] 8.5 [ 1.9 ] cfu/g ; 0.8 g/dL group , 7.7 [ 6.1 ] cfu/g ; and the placebo group , 8.8 [ 6.1 ] cfu/g ) ( figures in square brackets are interquartile range ) . At the end of the 28-day feeding period , the number of Bifidobacteria was significantly increased for both groups receiving supplemented formulas ( the 0.4 g/dL group , 9.3 [ 4.9 ] cfu/g ; the 0.8 g/dL group , 9.7 [ 0.8 ] cfu/g ) versus the placebo group ( 7.2 [ 4.9 ] cfu/g , P < 0.001 ) . This effect was dose dependent ( 0.4 g/dL versus 0.8 g/dL , P < 0.01 ) . The number of Lactobacilli also increased significantly in both groups fed the supplemented formulas ( versus placebo , P < 0.001 ) , but there was no statistically significant difference between the group fed formula with 0.4 g/dL oligosaccharides and the group fed formula with 0.8 g/dL oligosaccharides . The dosage of supplement significantly influenced the change in fecal pH ( P < 0.05 ) ( placebo , pH 5.5–6.1 ; 0.4 g/dL formula , pH 5.48–5.44 ; 0.8 g/dL formula , pH 5.54–5.19 ) . Slight changes in the stool frequency result ed in a significant difference between the placebo group and the group fed the 0.8 g/dL formula at day 28 ( P < 0.01 ) . Supplementation had a significant dose-dependent influence on stool consistency ( 0.8 g/dL versus placebo , P < 0.0001 ; 0.8 g/dL versus 0.4 g/dL , P < 0.01 ) . Supplementation had no influence on the incidence of side effects ( crying , regurgitation , vomiting ) or growth . Conclusions These data indicate that supplementation of a term infant 's formula with a mixture of galacto- and fructooligosaccharides has a dose-dependent stimulating effect on the growth of Bifidobacteria and Lactobacilli in the intestine and results in softer stool with increasing dosage of supplementation

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992.

OBJECTIVES Our goals were to determine the mortality risk for infants weighing 501 to 1500 gm according to gestational age , birth weight , and gender and to document birth weight-related changes in mortality and morbidity over a 5-year time period . STUDY DESIGN In this observational study perinatal data were prospect ively collected by the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network from May 1991 through December 1992 and compared with the corresponding data from 1987 through 1990 . St and ard definitions were used to record sociodemographic factors , perinatal events , and the neonatal course to 120 days of life , discharge , or death . RESULTS The 1991 and 1992 cohort included 4279 in-born infants . Among their mothers 10 % were < 18 years old ; 55 % were black , 31 % were white , and 11 % were Hispanic ; 14 % had received no prenatal care ; and 20 % had received antenatal corticosteroids . Multiple gestations accounted for 20 % of the births . Fifty percent of the infants were delivered by cesarean section . During 1991 and 1992 the overall survival for infants weighing 501 to 1500 gm at birth was 81 % , compared with 74 % in 1987 and 1988 . Survival at birth weight 501 to 750 gm was 44 % ; it was 81 % at 751 to 1000 gm , 92 % at 1001 to 1250 gm , and 95 % between 1251 and 1500 gm . Female infants had a significantly greater chance of surviving than male infants at similar birth weights and gestational ages . At any given gestational age , smaller infants were less likely to survive . Survival in all birth weight categories increased between 1987 and 1992 , without accompanying increases in medical morbidity . Major morbidity increased with decreasing birth weight and included late-onset septicemia 22 % , chronic lung disease ( oxygen dependence at 36 weeks ' corrected age ) 18 % , severe intraventricular hemorrhage ( grade s III and IV ) 11 % , and necrotizing enterocolitis 5 % . Twelve percent of all infants were treated with corticosteroids for chronic lung disease , including 36 % of infants who were oxygen dependent at age 28 days . The mean length of hospital stay was 69 days for survivors and 18 days for infants who died . CONCLUSIONS Mortality for infants between 501 and 1500 gm at birth has declined over the past 5 years . There are interactions between birth weight , gestational age , gender , and survival rate . This increase in survival was not accompanied by an increase in medical morbidity

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

A Specific Prebiotic Mixture Added to Starting Infant Formula Has Long-Lasting Bifidogenic Effects123

There is some evidence that early colonization of the intestine affects the composition of the intestinal microbiota after weaning . In the present study , the effect of prebiotics administered from the first day of life on fecal counts of bifidobacteria and lactobacilli were studied during and after the administration of the prebiotics . In this double-blind , r and omized , placebo-controlled , explorative study , 20 newborns of hepatitis C virus-infected mothers who decided not to breast feed due to their concerns regarding their plasma viral load were r and omly assigned to either a formula with 8 g/L of a specific prebiotic mixture ( short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides , ratio 9:1 ) or a formula containing the same amount of maltodextrin ( placebo ) . Clinical examination including anthropometric measurements , microbiological analysis of fecal sample s , and blood leukocyte population analysis were performed at birth and 3 , 6 , and 12 mo age . At the age of 12 mo , hepatitis B vaccine-specific IgG serum titers ( Hepatitis B virus surface antibodies ) were also measured . Prebiotic supplementation result ed in more fecal bifidobacteria ( P < 0.0001 ) and lactobacilli ( P = 0.0044 ) compared with the placebo group . These differences between the groups were maintained during the second half of the first year without any prebiotic supplementation . There was no influence of the different diets on anthropometric data or the measured immunological variables . The data from this small explorative study indicate that early colonization of the intestine might have long-lasting effects on the composition of the intestinal microbiota

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Supplementation of a bovine milk formula with an oligosaccharide mixture increases counts of faecal bifidobacteria in preterm infants

Background : The establishment of a balanced intestinal microflora which may protect against infection is desirable for the preterm infant . Objective : To investigate the effect of a preterm formula milk supplement consisting of oligosaccharides in similar proportions to human milk on the faecal flora and stool characteristics of preterm infants . Study design : To resemble the effect of human milk , an oligosaccharide mixture consisting of 90 % galacto-oligosaccharides and 10 % fructo-oligosaccharides was used to supplement a st and ard preterm formula at a concentration of 10 g/l . This supplemented formula was studied in 15 preterm infants , and the results were compared with those found in 15 infants fed a formula supplemented with maltodextrin as placebo . A group fed fortified mother 's milk was investigated as a reference group ( n = 12 ) . On four days during a 28 day feeding period ( 1 , 7 , 14 , and 28 ) , the faecal flora was investigated , and stool characteristics , growth , and possible side effects were recorded . Results : During the study period , the number of bifidobacteria in the group fed the oligosaccharide supplemented formula increased to the upper range of bifidobacteria counts in the reference group . The difference between the supplemented and non-supplemented groups was highly significant ( p = 0.0008 ) . The stool characteristics were also influenced by the supplement : the stool frequency after 28 days was significantly lower in the control group than in the oligosaccharide supplemented group ( p = 0.0079 ) and the reference group ( p < 0.0001 ) . Over the study period , the stool consistency in the control group became harder , but remained fairly stable in the other two groups . There was no effect of the different diets on the incidence of side effects ( crying , regurgitation , vomiting ) or on weight gain or length gain . Conclusion : Supplementing preterm formula with a mixture of galacto- and fructo-oligosaccharides at a concentration of 10 g/l stimulates the growth of bifidobacteria in the intestine and results in stool characteristics similar to those found in preterm infants fed human milk . Therefore prebiotic mixtures such as the one studied may help to improve intestinal tolerance to enteral feeding in preterm infants

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Prebiotic Effect Of Fructo-Oligosaccharide Supplemented Term Infant Formula at Two Concentrations Compared with Unsupplemented Formula and Human Milk

Background : Human milk components , including oligosaccharides , affect the gastrointestinal flora of infants . Previous studies in adults have demonstrated that fructo-oligosaccharides increase potentially beneficial fecal bacteria , including bifidobacteria . The purpose of this study was to determine the prebiotic effect of infant formula supplemented with fructo-oligosaccharides . Methods : Healthy term infants 2 to 6 weeks of age were enrolled in a 5-week , prospect i ve , r and omized , crossover , single-site study with a nonr and omized human milk comparator group . Washout weeks preceded and followed a week of feeding with fructo-oligosaccharide-supplemented formula ( 1.5 or 3.0 g/L ) . Stool specimens were quantitatively cultured weekly for bacteroides , lactobacilli , bifidobacteria , clostridia and enterococci and were tested for Clostridium difficile toxin . Results : Seventy-two of 87 infants completed the trial ; 58 were formula fed and 14 were human milk fed . Mean counts of bifidobacteria and lactobacilli were similar in all groups at entry and no group experienced a significant change in counts with fructo-oligosaccharide supplementation . After 7 days of fructo-oligosaccharide supplementation the bifidobacteria counts were greater in the 1.5 g/L fructo-oligosaccharide formula group than in the human milk fed or 3.0 g/L fructo-oligosaccharide formula groups . Formula-fed infants had higher counts of enterococci and bacteroides before fructo-oligosaccharide supplementation , and these counts did not change after supplementation . Clostridium counts increased 7 days after supplementation in the 1.5 g/L fructo-oligosaccharide formula group ( P = 0.0356 ) . No human milk fed infants had C. difficile toxin in stools . Fructo-oligosaccharide ( 3.0 g/L ) supplementation result ed in more frequent and significantly softer stools . Conclusions : Infant formula supplemented with 1.5 or 3.0 g/L fructo-oligosaccharides was safe but had minimal effect on fecal flora and C. difficile toxin

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The Effect of Neutral Oligosaccharides on Reducing the Incidence of Necrotizing Enterocolitis in Preterm infants: A Randomized Clinical Trial

Background : Necrotizing enterocolitis ( NEC ) is one of the most destructive diseases associated with conditions of neonatal prematurity . Supplementation with enteral prebiotics may reduce the incidence of NEC , especially in infants who fed exclusively with breast-milk . Therefore , we compared the efficacy and safety of enteral supplementation of a prebiotic mixture ( short chain galacto-oligosaccharides/long chain fructo-oligosaccharides [ SCGOS/LCFOS ] ) versus no intervention on incidence of NEC in preterm infants . Methods : In a single-center r and omized control trial 75 preterm infants ( birth weight [ BW ] ≤1500 g , gestational age ≤34 weeks and were not fed with formula ) on 30 ml/kg/day volume of breast-milk were r and omly allocated to have enteral supplementation with a prebiotic mixture ( SCGOS/LCFOS ; 9:1 ) or not receive any prebiotic . The incidence of suspected NEC , feeding intolerance , time to full enteral feeds , duration of hospitalization were investigated . Results : Differences in demographic characteristics were not statistically important . SCGOS/LCFOS mixture significantly reduced the incidence of suspected NEC , ( 1 [ 4.0 % ] vs. 11 [ 22.0 % ] ; hazard ratio : 0.49 [ 95 % confidence interval : 0.29 - 0.84 ] ; P = 0.002 ) , and time to full enteral feeds ( 11 [ 7 - 21 ] vs. 14 [ 8 - 36 ] days ; P - 0.02 ] . Also duration of hospitalization was meaningfully shorter in the prebiotic group ( 16 [ 9 - 45 ] vs. 25 [ 11 - 80 ] ; P - 0.004 ] . Prebiotic oligosaccharides were well tolerated by very low BW ( VLBW ) infants . Conclusions : Enteral supplementation with prebiotic significantly reduced the incidence of NEC in VLBW infants who were fed exclusively breast-milk . This finding suggests that it might have been the complete removal of formula which caused a synergistic effect between nonhuman neutral oligosaccharides ( prebiotic ) and human oligosaccharides

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The effect of a fructo-oligosaccharide supplemented formula on gut flora of preterm infants.

AIM The intestinal flora of breast-fed infants is generally dominated by bifidobacteria which have beneficial properties . Their presence is due to various components of breast milk , including prebiotic substances . This prospect i ve double-blind study compared the numbers of bifidobacteria in the stool flora of bottle-fed preterm infants r and omized to receive for 14 days either a formula with prebiotic fructo-oligosaccharides at a concentration of 0.4 g/dL or the same formula with maltodextrin as a placebo . METHODS Within 0 - 14 days after birth , 56 healthy bottle-fed infants were enrolled to receive either the prebiotic or placebo . Faecal sample s were taken at inclusion day and at study day 7 . The number of bifidobacteria in the stools , stool characteristics and somatic growth were recorded during the study . RESULTS In the group fed fructo-oligosaccharides , both the numbers of bifidobacteria in the stools and the proportion of infants colonized with them were significantly higher as compared to the placebo group ( p=0.032 and p=0.030 respectively ) . There was also a higher number of bacteroids in the fructo-oligosaccharide group as compared to the placebo ( p=0.029 ) . At the same time , reduction was noted in the numbers of Escherichia coli and enterococci . ( p=0.029 , and p=0.025 , respectively ) . Supplementation had also significant influence on stool frequency per day ( p=0.0080 ) . CONCLUSION An infant formula containing a small quantity of prebiotic oligosaccharides is well accepted and leads to rapid growth of bifidobacteria in the gut of bottle-fed preterm infants while decreasing the numbers of pathogenic microorganisms

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Conditions of Bifidobacterial Colonization in Preterm Infants: A Prospective Analysis

Background : Premature birth results in a delayed and abnormal qualitative pattern of gut colonization . This abnormal pattern is thought to affect intestinal development and contribute to a higher risk of gastrointestinal infectious diseases such as neonatal necrotizing enterocolitis ( NEC ) . In particular , bifidobacteria are thought to play a major role . We therefore studied bifidobacterial colonization in preterm infants during the first month of life . Patients and Methods : Fecal sample s were prospect ively analyzed in 52 infants born at a gestational age ranging from 30 to 35 weeks fed with a preterm formula alone and , in 18 , with their mother 's milk . Fecal sample s were collected twice per week during the hospital stay . Bifidobacterial colonization was analyzed with culture and a molecular method . Results : Bifidobacterial colonization occurred in 18 infants at a median age of 11 days , always greater than the corrected mean gestational age of 35.4 weeks ( SD , 0.9 ) and greater than 34 weeks for 16 of 18 . Colonization by bifidobacteria was affected by neither birthweight nor mode of delivery nor antibiotics given to the mother or infant . In contrast , birth gestational age had a significant impact on colonization by bifidobacteria ( P < 0.05 ) , which always occurred in children born at a birth gestational age greater than 32.9 weeks ( P < 0.05 ) . Conclusions : Birth gestational age seems to act as a major determinant of bifidobacterial colonization in the premature infant , suggesting the role of gut maturation , a finding that should probably be taken into account in manipulations of the gut flora aim ed at reducing NEC

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Human milk oligosaccharides are associated with protection against diarrhea in breast-fed infants.

OBJECTIVE To determine the association between maternal milk levels of 2-linked fucosylated oligosaccharide and prevention of diarrhea as a result of Campylobacter , caliciviruses , and diarrhea of all causes in breast-fed infants . STUDY DESIGN Data and banked sample s were analyzed from 93 breast-feeding mother-infant pairs who were prospect ively studied during 1988 - 1991 from birth to 2 years with infant feeding and diarrhea data collected weekly ; diarrhea was diagnosed by a study physician . Milk sample s obtained 1 to 5 weeks postpartum were analyzed for oligosaccharide content . Data were analyzed by Poisson regression . RESULTS Total 2-linked fucosyloligosaccharide in maternal milk ranged from 0.8 to 20.8 mmol/L ( 50%-92 % of milk oligosaccharide ) . Moderate-to-severe diarrhea of all causes ( n=77 cases ) occurred less often ( P=.001 ) in infants whose milk contained high levels of total 2-linked fucosyloligosaccharide as a percent of milk oligosaccharide . Campylobacter diarrhea ( n=31 cases ) occurred less often ( P=.004 ) in infants whose mother 's milk contained high levels of 2'-FL , a specific 2-linked fucosyloligosaccharide , and calicivirus diarrhea ( n=16 cases ) occurred less often ( P=.012 ) in infants whose mother 's milk contained high levels of lacto-N-difucohexaose ( LDFH-I ) , another 2-linked fucosyloligosaccharide . CONCLUSION This study provides novel evidence suggesting that human milk oligosaccharides are clinical ly relevant to protection against infant diarrhea

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

A Randomized, Double-Blind, Controlled Trial of the Effect of Prebiotic Oligosaccharides on Enteral Tolerance in Preterm Infants (ISRCTN77444690)

Breast milk prebiotic oligosaccharides are believed to promote enteral tolerance . Many mothers delivering preterm are unable to provide sufficient milk . We conducted a multicenter , r and omized , controlled trial comparing preterm formula containing 0.8 g/100 mL short-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides in a 9:1 ratio and an otherwise identical formula , using formula only to augment insufficient maternal milk volume . Infants were r and omized within 24 h of birth . The primary outcome ( PO ) was time to establish a total milk intake of 150 mL/kg/d PO and the principal secondary outcome ( PSO ) was proportion of time between birth and 28 d/discharge that a total milk intake of ≥150 mL/kg/d was tolerated . Other secondary outcomes included growth , fecal characteristics , gastrointestinal signs , necrotizing enterocolitis , and bloodstream infection . Outcomes were compared adjusted for prespecified covariates . We recruited 160 infants appropriately grown for GA <33 wk . There were no significant differences in PO or PSOs . After covariate adjustment , we showed significant benefit from trial formula in PSO with increasing infant immaturity ( 2.9 % improved tolerance for a baby born at 28-wk gestation and 9.9 % at 26-wk gestation ; p < 0.001 ) but decreased or no benefit in babies > 31-wk gestation . Prebiotic supplementation appears safe and may benefit enteral tolerance in the most immature infants

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Prebiotic oligosaccharides reduce stool viscosity and accelerate gastrointestinal transport in preterm infants.

AIM To investigate whether a mixture of prebiotic non-digestible oligosaccharides ( GosFos ; referring to galacto- and fructo-oligosaccharides ) would improve feeding tolerance in preterm infants on full enteral formula feeding . We hypothesized that GosFos would : ( 1 ) reduce stool viscosity and ( 2 ) accelerate gastrointestinal transport . METHODS In a placebo-controlled double-blind trial 20 preterm infants on full enteral nutrition ( gestational age 27 ( 24 - 31 ) weeks , postnatal age 42 ( 11 - 84 ) days , and weight at study entry 1570 ( 1080 - 2300 ) g were r and omly allocated to have their feedings supplemented with either GosFos ( 1 g/100 mL ) or placebo for 14 days . Stool viscosity was measured by high-pressure capillary rheometry . Gastrointestinal transport time was assessed as the time from feeding carmine red to its appearance in the diaper . The hypotheses were tested as a priori ordered hypotheses . Data are shown as median ( range ) . RESULTS Birth weight , gestational age , postnatal age , and weight at study entry did not differ between groups . GosFos significantly reduced both stool viscosity , as measured by extrusion force ( 32 ( 2 - 67 ) versus 158 ( 24 - 314 ) N ) , and gastrointestinal transit time ( 12 ( 4 - 33 ) versus 26 ( 5 - 52 ) h ) . No adverse effects were observed . CONCLUSION Formula supplementation with GosFos reduced stool viscosity and accelerated gastrointestinal transport . Further trials are required to investigate whether GosFos facilitates enteral feeding advancement and early enteral nutrition thereby eventually reducing the incidence of catheter-related nosocomial infections and improving long-term outcome

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Randomized Double-Blind Study of the Nutritional Efficacy and Bifidogenicity of a New Infant Formula Containing Partially Hydrolyzed Protein, a High &bgr;-Palmitic Acid Level, and Nondigestible Oligosaccharides

Objectives The aim of this study was to evaluate the nutritional efficacy and bifidogenic characteristics of a new infant formula containing partially hydrolyzed whey protein , modified vegetable oil with a high & bgr;-palmitic acid content , prebiotic oligosaccharides , and starch . Methods In a double-blind study , healthy formula-fed term infants aged younger than 2 weeks were r and omized to receive either the new infant formula ( NF ) or a st and ard formula ( SF ) until the age of 12 weeks . Anthropometric measurements were taken at enrollment , 6 weeks , and 12 weeks . In a sub sample of infants , blood sample s were taken at 6 weeks and stool sample s were taken at enrollment and 6 weeks . Blood sample s were analyzed for biochemical measures of protein status and amino acids , and stools were analyzed for total bacteria and bifidobacteria . Mothers completed a feeding diary and question naire at 6 and 10 weeks . Results One hundred fifty-four infants were enrolled in the study ; 102 completed the trial . The growth of infants in both formula groups was in line with published growth curves . During the first 6 weeks , NF girls gained more weight and head circumference than the SF girls . These velocity differences were not maintained throughout the 12-week study period . The NF stools had a higher proportion of bifidobacteria at 6 weeks compared with the SF stools , and they were softer . There were no clinical ly significant differences in the blood biochemical and amino acid values between groups . Both formulas were well tolerated by the infants . Conclusions When compared with a st and ard infant formula , the new formula supported satisfactory growth , led to higher counts of bifidobacteria in the feces , produced blood bio-chemical values typical of formula-fed infants , and was well tolerated

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The effect of a prebiotic supplemented formula on growth and stool microbiology of term infants.

BACKGROUND The intestinal flora of breast-fed infants is generally dominated by bifidobacteria which have beneficial properties . Their presence is due to various compounds of breast milk including prebiotic substances . AIM This prospect i ve , double blind , study compared the growth , acceptability and the proportion of bifidobacteria and clostridia in the stool flora of bottle-fed infants r and omized to receive a formula with a specific mixture of 0.4 g/100 ml prebiotic galacto- and long-chain fructooligosaccharides or the same formula without added prebiotics . METHODS Within 0 - 14 days after birth at term , healthy bottle-fed infants were enrolled to receive either a prebiotic formula or a st and ard formula . At recruitment anthropometric measurements were done . These were repeated at the age of 6 and 12 weeks . Stool sample s were taken at inclusion and at the age of 6 weeks . The number of bifidobacteria and clostridia was determined by fluorescent in situ hybridization . RESULTS There was good tolerance of the prebiotic formula . Somatic growth was similar in the two groups . Stool frequency was significantly higher in the prebiotic group ( P=0.031 ) . Infants in the prebiotic group had also softer stools as compared to the control group ( P=0.026 ) . Baseline values of microorganisms at study entry were similar . The percentage of faecal clostridia at the completion of the study was significantly lower in the prebiotic group ( P=0.042 ) , while the proportion of faecal bifidobacteria was higher in the prebiotic group as compared to the control group . However this difference did not reach statistical significance ( P=0.262 ) . The percentage of E. coli was lower in the prebiotic group but again this did not reach statistical significance ( P=0.312 ) . CONCLUSION An infant formula containing prebiotic oligosaccharides is well tolerated , leads to normal somatic growth and suppresses the numbers of clostridia in the faeces with a trend for higher percentage of stool bifidobacteria and lower percentage of E. coli

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Prebiotics Improve Gastric Motility and Gastric Electrical Activity in Preterm Newborns

The aim of this double-blind , r and omized , placebo-controlled study was to evaluate the effect of a prebiotic mixture on gastric motility in preterm newborns . After a feeding period of 15 days , gastric electrical activity was measured by electrogastrography , and the gastric emptying time was studied by ultrasound technique . No difference was seen in the daily increase of body weight , and no adverse events have been reported . The percentage of time in which propagation was detected in the electrogastrography signal was twice in newborns receiving formula with prebiotics with respect to placebo , and the gastric half-emptying time was 30 % faster in the prebiotic group than the placebo group . Prebiotic oligosaccharides can modulate the electrical activity and the gastric emptying and may improve the intestinal tolerance of enteral feeding in preterm infants

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Term Infants Fed Formula Supplemented With Selected Blends of Prebiotics Grow Normally and Have Soft Stools Similar to Those Reported for Breast-fed Infants

Objectives : The present study was design ed to evaluate the effect of 2 different combinations of prebiotic ingredients , polydextrose ( PDX ) , galactooligosaccharides ( GOS ) , and lactulose ( LOS ) , at 2 different intake levels on the overall growth and tolerance in healthy term infants up to 120 days of age . Patients and Methods : Healthy , formula-fed , term infants ( n = 226 ) were r and omly assigned to 1 of 3 study formula groups : control group ( n = 76 ) , PG4 group ( control formula supplemented with 4 g/L of a prebiotic blend , n = 74 ) , or PGL8 group ( control formula supplemented with 8 g/L of a prebiotic blend , n = 76 ) . Anthropometric measurements were taken at 14 , 30 , 60 , 90 , and 120 days of age , and 24-hour dietary recall and 24-hour tolerance recall were recorded at 30 , 60 , 90 , and 120 days of age . Adverse events were recorded throughout the study . Results : There were no statistically significant differences among the 3 formula groups for weight growth rate or length growth rate at any time point . Significant differences in stool consistency were detected among the 3 formula groups at 30 , 60 , and 90 days of age ( P < 0.001 , P = 0.025 , P = 0.004 , respectively ) , with the supplemented formula groups having looser stools than the control group . The PGL8 group had significantly higher stool frequency compared with the control and PG4 groups at 30 days of age ( P = 0.021 and P = 0.017 , respectively ) , but all of the groups were similar at 60 , 90 , and 120 days of age . A statistical difference was detected among the formula groups in 3 categories of adverse events : diarrhea ( control vs PG4 , 4 % vs 18 % , P = 0.008 ) , eczema ( PG4 vs control , 18 % vs 7 % , P = 0.046 ; PG4 vs PGL8 , 18 % vs 4 % , P = 0.008 ) , and irritability ( control vs PGL8 , 4 % vs 16 % , P = 0.027 ) . Conclusions : Infants fed formula supplemented with a prebiotic mixture achieved normal growth and stool characteristics more similar to those of breast-fed infants in comparison with infants fed an unsupplemented formula . A pediatrician needs to consider the risk of possible intolerance against the benefits of prebiotics

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The effects of lactulose supplementation to enteral feedings in premature infants: a pilot study.

OBJECTIVE To assess the safety and prebiotic effects of lactulose in preterm infants . STUDY DESIGN This was a prospect i ve , double-blinded , placebo-controlled , single-center study in 23- to 34-weeks premature infants . The study group received 1 % lactulose , and control infants received 1 % dextrose in all feeds ( human milk or formula ) . RESULTS Twenty-eight infants participated ( 15 lactulose , 13 placebo ) . Small doses of lactulose appeared to be safe and did not cause diarrhea . Premature infants on lactulose had more Lactobacilli-positive stool cultures that appeared earlier with larger number of colonies . The lactulose group tended to have less intolerance to enteral feedings , to reach full oral feeds earlier , and to be discharged home earlier . They also tended to have fewer episodes of late-onset sepsis , lower Bell stage necrotizing enterocolitis , and their nutritional laboratory indices were better , especially calcium and total protein . CONCLUSIONS This pilot study supports the safety of supplementing preterm infants ' feeds with low doses of lactulose . It also demonstrated trends that may suggest positive prebiotic effects

Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance .

Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Effect of short-term ingestion of konjac glucomannan on serum cholesterol in healthy men.

The effects of the soluble fiber konjac glucomannan ( GM ) on serum cholesterol concentrations were investigated in 63 healthy men in a double-blind crossover , placebo-controlled study . After a 2-wk baseline period , the subjects were given 3.9 g GM or placebo daily for 4 wk . After a washout period of 2 wk , crossover took place , followed by another 4 wk of treatment . The subjects were encouraged not to change their ordinary diets or general lifestyle during the investigation . GM fibers reduced total cholesterol ( TC ) concentrations by 10 % ( P < 0.0001 ) , low-density-lipoprotein cholesterol ( LDL-C ) concentrations by 7.2 % ( P < 0.007 ) , triglycerides by 23 % ( P < 0.03 ) , and systolic blood pressure by 2.5 % ( P < 0.02 ) . High-density-lipoprotein cholesterol ( HDL-C ) and the ratio of LDL-C to HDL-C did not change significantly . No change in diastolic blood pressure or body weight was observed . No adverse effects were observed . The results of this study show that GM is an effective cholesterol-lowering dietary adjunct

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Experiences with three different fiber supplements in weight reduction.

BACKGROUND Fiber supplements added to a caloric diet have additional effects on weight reduction in overweight subjects . The aim of this study was to compare the effect of various commercial fiber supplements ( glucomannan , guar gum and alginate ) on weight reduction in healthy overweight subjects . MATERIAL / METHODS One hundred and seventy six men and women were included to receive either active fiber substance or placebo in r and omized placebo-controlled studies . The fiber supplements consisted of the viscous fibers glucomannan ( Chrombalance ) , glucomannan and guar gum ( Appe-Trim ) and glucomannan , guar gum and alginat ( Glucosahl ) . RESULTS All fiber supplements plus a balanced 1200 kcal diet induced significantly weight reduction more than placebo and diet alone , during a five week observation period . However , there were no significant differences between the different fibers in their ability to induce weight reduction , which was approximately 0.8 kg/week ( 3.8 + /- 0.9 , 4.4 + /- 2.0 , 4.1 + /- 0.6 in the Chrombalance , Appe-Trim and Glucosahl group , respectively ) . CONCLUSIONS Glucomannan induced body weight reduction in healthy overweight subjects , whereas the addition of guar gum and alginate did not seem to cause additional loss of weight

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Childhood obesity treatment: double blinded trial on dietary fibres (glucomannan) versus placebo.

Dietary fibres are frequently used for the treatment of paediatric obesity . The aim of this clinical trial is to evaluate the efficacy of glucomannan in the child obesity management . This experimental design was double blinded with a block r and omisation , alpha = 0.05 , beta = 0.2 and delta = 50 % . The study involved 60 children under 15 years of age ( mean age 11.2 years , mean overweight 46 % ) , 30 of them under glucomannan treatment ( 1 g twice a day for two months ) and 30 under placebo and the same schedule . The drug and the placebo were indistinguishable both for the family and the physician . During the two months study period the children followed a normocaloric diet evaluated every two weeks by a dietetic record book . At the beginning of the study the drug and the placebo groups were comparable in regards to anthropometric data . At the end , the mean overweight of the drug group was decreased from 49.5 % to 41 % and that of the placebo group from 43.9 % to 41.7 % . Both decreases were significant ( p < 0.01 ) , but no significant difference was observed between the drug and the placebo groups . The only significant difference concerned the lipid metabolism . The children under glucomannan treatment manifested a significant decrease of alpha-lipoprotein and an increase of pre-beta-lipoprotein and triglycerides ; the children under placebo manifested only a decrease of triglycerides and apo beta-lipoprotein . We suggest that this metabolic alteration may derive from a primary decrease of alpha-lipoprotein , most likely because of an inadequate water intake . ( ABSTRACT TRUNCATED AT 250 WORDS

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Effects of a carbohydrate-restricted diet with and without supplemental soluble fiber on plasma low-density lipoprotein cholesterol and other clinical markers of cardiovascular risk.

Carbohydrate-restricted diets ( CRDs ) promote weight loss , reductions in plasma triacylglycerol ( TAG ) levels , and increases in high-density lipoprotein cholesterol ( HDL-C ) levels but may cause undesirable low-density lipoprotein cholesterol ( LDL-C ) responses in some people . The objective of the present study was to determine the effect of adding soluble fiber to a CRD on plasma LDL-C and other traditionally measured markers of cardiovascular disease . Using a parallel-arm , double-blind , placebo-controlled design , 30 overweight and obese men ( body mass index , 25 - 35 kg/m(2 ) ) were r and omly assigned to supplement a CRD with soluble fiber ( Konjac-mannan , 3g/d ) ( n = 15 ) or placebo ( n = 15 ) . Plasma lipids , anthropometrics , body composition , blood pressure , and nutrient intake were evaluated at baseline and at 6 and 12 weeks . Compliance was excellent as assessed by 7-day weighed dietary records and ketonuria . Both groups experienced decreases in ( P < .01 ) body weight , percent body fat , systolic blood pressure , waist circumference , and plasma glucose levels . After 12 weeks , HDL-C and TAG improved significantly in the fiber ( 10 % and -34 % ) and placebo ( 14 % , -43 % ) groups . LDL-C decreased by 17.6 % ( P < .01 ) at week 6 and 14.1 % ( P < .01 ) at week 12 in the fiber group . Conversely , LDL-C reductions were significant in the placebo group only after 12 weeks ( -6.0 % , P < .05 ) . We conclude that although clearly effective at lowering LDL-C , adding soluble fiber to a CRD during active and significant weight loss provides no additional benefits to the diet alone . Furthermore , a CRD led to clinical ly important positive alterations in cardiovascular disease risk factors

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Effect of dietary supplementation with glucomannan on plasma total cholesterol and low density lipoprotein cholesterol in hypercholesterolemic children.

AIM This paper evaluates the effect of the adjunct of the hydrosoluble fiber glucomannan to a Step-One-Diet in 40 plasma hypercholesterolemic children , during a r and omized controlled trial , to reduce plasma cholesterol . METHODS All the subjects recruited underwent an 8-week run in diet period ; a Step-One-Diet was prescribed . After that , they were r and omly allocated to one of two groups : Step-One-Diet only ( control ) , and Step-One-Diet plus glucomannan in gelatine capsules . After another 8 weeks of treatment , the results were compared within and between the two groups . RESULTS Glucomannan treated group showed decreased values in plasma total cholesterol ( TC ) and low density lipoprotein cholesterol ( LDL-C ) vs. control group after 8 weeks of treatment . The percentage decrease showed a statistically significant difference between sex groups . Decreases were observed in favor of female vs. male children in TC ( 24 % vs. 9 % ) and LDL-C ( 30 % vs. 9 % ) . CONCLUSIONS These results suggest that glucomannan may represent a rationale adjunct to diet therapy in primary prevention in high risk hypercholesterolemic children

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

[The use of highly purified glucomannan-based fibers in childhood obesity].

To evaluate the effectiveness of highly purified glucomannan in childhood obesity a study has been carried out in 23 obese children ( 12 boys and 11 girls , aged 5.2 - 15.8 years ) , with excess weight of 51 + /- 16 % , treated with 2 - 3 caps twice a day of glucomannan fibres ( DICOMAN 5:2 - 3 gr/die ) , and in 30 obese children ( aged 5 - 18 years ) with excess weight of 51 + /- 10 % , studied as controls . After a three-days food recall , a balanced diet with adequate caloric intake was provided to all obese children . In all patients before and 2 - 4 months after the auxological data ( weight , height , weight excess ) and laboratory data ( serum levels of cholesterol , HDL , triglycerides , glucose , fructosamine , glycosylated hemoglobin , RBC , WBC , hemoglobin , iron , calcium , Cu and Zn ) have been determined . Excess weight and triglycerides levels were significantly decreased in treated obese patients than in obese controls 4 months after the beginning of the study . A decrease of cholesterol levels was also observed in treated obese patients , but not in controls , whereas serum iron , calcium , copper and zinc persisted unchanged . No important side-effects were observed in treated patients . On the basis of our results highly purified glucomannan fibres may be employed with effectiveness in obese and dyslipidemic children together with diet

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Effect of plant sterols and glucomannan on lipids in individuals with and without type II diabetes

Objective : The purpose of this study was to determine whether supplements of plant sterols and /or glucomannan improve lipid profile and cholesterol bio synthesis in mildly hypercholesterolemic type II diabetic and non-diabetic subjects and to compare the response of these two subject groups to the treatments . Design : A r and omized , crossover study consisting of four phases of 21 days , with each phase separated by a 28-day washout . Setting : The Mary Emily Clinical Nutrition Research Unit of McGill University . Subjects : Eighteen non-diabetic individuals and 16 type II diabetic individuals aged 38–74 years . Interventions : Subjects were supplemented with plant sterols ( 1.8 g/day ) , glucomannan ( 10 g/day ) , a combination of glucomannan and plant sterols , and a placebo , provided in the form of bars . Results : Overall plasma cholesterol concentrations were lowered ( P<0.05 ) after combination treatment ( 4.72±0.20 mmol/l ) compared to control ( 5.47±0.18 mmol/l ) . Plasma low-density lipoprotein ( LDL ) cholesterol concentrations were decreased ( P<0.05 ) after glucomannan ( 3.16±0.14 mmol/l ) and combination treatments ( 2.95±0.16 mmol/l ) compared to control ( 3.60±0.16 mmol/l ) . The results of lipid profiles did not differ between subject groups . Overall plasma lathosterol concentrations , an index of cholesterol bio synthesis , were lowered ( P<0.05 ) after the combination treatment compared to the plant sterol treatment . Conclusions : The results suggest that glucomannan and a combination of glucomannan and plant sterols substantially improves plasma LDL cholesterol concentrations . Sponsorship : Forbes Medi-Tech Inc. , Vancouver , British Columbia , Canada

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Konjac Supplement Alleviated Hypercholesterolemia and Hyperglycemia in Type 2 Diabetic Subjects—A Randomized Double-Blind Trial

Objectives : The present study was design ed to evaluate effects of konjac glucomannan ( KGM ) supplement ( 3.6 g/day ) for 28 days on blood lipid and glucose levels in hyperlipidemic type 2 diabetic patients and the possible mechanism for the reductions in blood lipid levels . Methods : Twenty-two diabetic subjects ( age 64.2 + 8.4 years , BMI 25.5 + 3.2 kg/m2 ) with elevated blood cholesterol levels ( fasting glucose between 6.7–14.4 mmol/L ) , but currently not taking lipid-lowering medication , were recruited to participate in a two 28-day period , r and omized , double-blind , crossover clinical trial . Fasting blood sample s drawn on the initial and final days of each period were determined for plasma lipids and glucose levels . Feces collected at the end of each experimental period were analyzed for neutral sterol and bile acid contents . Results : Compared with placebo , KGM effectively reduced plasma cholesterol ( 11.1 % , p = 0.0001 , adjusted α = 0.006 ) , LDL-cholesterol ( 20.7 % , p = 0.0004 , adjusted α = 0.006 ) , total/HDL cholesterol ratio ( 15.6 % , p = 0.0005 , adjusted α = 0.007 ) , ApoB ( 12.9 % , p = 0.0001 , adjusted α = 0.006 ) and fasting glucose ( 23.2 % , p = 0.002 , adjusted α = 0.008 ) . Plasma triglyceride , HDL-cholesterol , LDL/HDL cholesterol , postpr and ial glucose and body weight were not significant after adjustment by the Bonferroni-Hochberg procedure . Fecal neutral sterol and bile acid concentrations were increased by 18.0 % ( p = 0.004 ) and 75.4 % ( p < 0.001 ) , respectively , with KGM supplement . Conclusions : The KGM supplement improved blood lipid levels by enhancing fecal excretion of neutral sterol and bile acid and alleviated the elevated glucose levels in diabetic subjects . KGM could be an adjunct for the treatment of hyperlipidemic diabetic subjects

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Effect of glucomannan on obese patients: a clinical study.

An eight-week double-blind trial was conducted to test purified glucomannan fiber as a food supplement in 20 obese subjects . Glucomannan fiber ( from konjac root ) or placebo was given in 1-g doses ( two 500 mg capsules ) with 8 oz water , 1 h prior to each of three meals per d. Subjects were instructed not to change their eating or exercise patterns . Results showed a significant mean weight loss ( 5.5 lbs ) using glucomannan over an eight-week period . Serum cholesterol and low-density lipoprotein cholesterol were significantly reduced ( 21.7 and 15.0 mg/dl respectively ) in the glucomannan treated group . No adverse reactions to glucomannan were reported

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Glycemic and lipid responses to glucomannan in Thais with type 2 diabetes mellitus.

OBJECTIVE To evaluate the benefits of glucomannan supplement on glycemic and lipid controls in type 2 diabetic patients . MATERIAL AND METHOD A single-blind , placebo-controlled , crossover trial with two treatments separated by a 2-week washout period was performed in 10 men and 10 women with type 2 diabetes mellitus . Two separated protocol s of experiments were sequentially followed . Initially , purified glucomannan ( 1 g ) or placebo was ingested 30 min before 75-g glucose load to evaluate their effects on glucose absorption and insulin secretion in oral glucose tolerance test ( OGTT ) . Later , the glycemic and lipid changes after 4-week intervention with 3 g/day glucomannan comparing to the placebo were determined . The st and ard OGTT was performed before and after ending of each intervention . RESULTS Glucomannan taken before performing the OGTT can lower the rise of blood glucose and insulin from 1 to 2 hour in comparison with the placebo , though a statistically significance of insulin was not achieved . Long-term glucomannan supplement significantly reduced the 120-min glucose area under the curve of OGTT . Glucomannan also decreased the rise of low-density lipoprotein cholesterol ( LDL-C ) . Reductions of HOMA-insulin resistance index and body mass index were detected in glucomannan-treated group though the former was shown only in females . No within- and between-group differences of insulin , fructosamine , and other lipids were observed in glucomannan- nor placebo- treated groups . CONCLUSION In type 2 diabetes , pre-pr and ial glucomannan ingestion attenuated a rise of blood glucose without significantly affecting insulin levels . Long-term supplement of glucomannan to the regular diabetic regimen lessened post challenge glucose AUC and impeded the rise of LDL-C. Supplement of glucomannan may be beneficial to the glycemic and lipid controls in type 2 diabetes mellitus

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

[Chronic use of glucomannan in the dietary treatment of severe obesity].

Two groups of 25 severely obese patients underwent 3 months of hypocaloric diet therapy either alone or associated with a glucomannan-based fibrous diet supplement ( approx . 4 g/die in 3 doses ) . The comparative analysis of the results obtained in both groups showed that the diet + glucomannan group had a more significant weight loss in relation to the fatty mass alone , an overall improvement in lipid status and carbohydrate tolerance , and a greater adherence to the diet in the absence of any relevant side effects . Due to the marked ability to satiate patients and the positive metabolic effects , glucomannan diet supplements have been found to be particularly efficacious and well tolerated even in the long-term treatment of severe obesity

The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP

BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP .

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

Autonomic cardiovascular regulation in subjects with acute mountain sickness.

The aims of this study were 1 ) to evaluate whether subjects suffering from acute mountain sickness ( AMS ) during exposure to high altitude have signs of autonomic dysfunction and 2 ) to verify whether autonomic variables at low altitude may identify subjects who are prone to develop AMS . Forty-one mountaineers were studied at 4,559-m altitude . AMS was diagnosed using the Lake Louise score , and autonomic cardiovascular function was explored using spectral analysis of R-R interval and blood pressure ( BP ) variability on 10-min resting recordings . Seventeen subjects ( 41 % ) had AMS . Subjects with AMS were older than those without AMS ( P < 0.01 ) . At high altitude , the low-frequency ( LF ) component of systolic BP variability ( LF(SBP ) ) was higher ( P = 0.02 ) and the LF component of R-R variability in normalized units ( LF(RR)NU ) was lower ( P = 0.001 ) in subjects with AMS . After 3 mo , 21 subjects ( 43 % with AMS ) repeated the evaluation at low altitude at rest and in response to a hypoxic gas mixture . LF(RR)NU was similar in the two groups at baseline and during hypoxia at low altitude but increased only in subjects without AMS at high altitude ( P < 0.001 ) and did not change between low and high altitude in subjects with AMS . Conversely , LF(SBP ) increased significantly during short-term hypoxia only in subjects with AMS , who also had higher resting BP ( P < 0.05 ) than those without AMS . Autonomic cardiovascular dysfunction accompanies AMS . Marked LF(SBP ) response to short-term hypoxia identifies AMS-prone subjects , supporting the potential role of an exaggerated individual chemoreflex vasoconstrictive response to hypoxia in the genesis of AMS

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

Reproducibility of Acute Mountain Sickness in Children and Adults: A Prospective Study

OBJECTIVE : Although a history of previous acute mountain sickness ( AMS ) is commonly used for providing advice and recommending its prophylaxis during subsequent exposure , the intraindividual reproducibility of AMS during repeated high-altitude exposure has never been examined in a prospect i ve controlled study . METHODS : In 27 nonacclimatized children and 29 adults , AMS was assessed during the first 48 hours after rapid ascent to 3450 m on 2 consecutive occasions 9 to 12 months apart . RESULTS : During the first exposure , 18 adults ( 62 % ) and 6 children ( 22 % ) suffered from AMS ; during the second exposure , 14 adults ( 48 % ) and 4 children ( 15 % ) suffered from this problem ( adults versus children , P ≤ .01 ) . Most importantly , the intraindividual reproducibility of AMS was very different ( P < .001 ) between children and adults . None of the 6 children having suffered from AMS during the first exposure suffered from AMS during the second exposure , but 4 children with no AMS during the first exposure did experience this problem during the second exposure . In contrast , 14 of the 18 adults who suffered from AMS on the first occasion also presented with this problem during the second exposure , and no new case developed in those who had not experienced AMS on the first occasion . CONCLUSIONS : In adults , a history of AMS is highly predictable of the disease on subsequent exposure , whereas in children it has no predictive value . A history of AMS should not prompt practitioners to advise against reexposure to high altitude or to prescribe drugs for its prophylaxis in children

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

Vascular endothelial growth factor and acute mountain sickness

Study Objective : Despite causing significant morbidity throughout the mountainous regions of the world , the pathophysiology of acute mountain sickness ( AMS ) remains poorly understood . This study aims to improve the underst and ing of altitude illness by determining if vascular endothelial growth factor ( VEGF ) plays a role in the development of AMS . The purpose of this study was to determine if elevated plasma VEGF correlates with increased symptoms of AMS at high altitude . Patients and Methods : This is a prospect i ve study of a cohort of healthy climbers on Denali ( Mount McKinley ) in Alaska at 14 , 200 feet . Baseline demographics , medications , rates of ascent , and AMS scores were recorded . Pulse oximetry measurements and venous blood sample s were obtained . Comparisons were made between mountaineers with and without AMS . Results : Seventy-two climbers were approached for participation in the study ; 21 ( 29 % ) refused . Of the 51 climbers participating in the study , 14 subjects ( 27.5 % ) had symptoms of AMS and 37 subjects ( 72.5 % ) were free of symptoms of AMS . Plasma VEGF levels were 79.14 pg/dl ( SD : 121.44 ) and 57.57pg/dl ( SD : 102.71 ) in the AMS and non-AMS groups , respectively . These results were nonsignificant . Similarly , comparison of sex , age , rate of ascent , pulse oximetry values , or history of altitude illness did not reveal significant differences between the AMS and non-AMS groups . Conclusion : This study does not provide evidence in support of the theory that plasma VEGF correlates with symptoms of AMS

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis.

Forty-seven climbers participated in a double-blind , r and omized trial comparing acetazolamide 250 mg , dexamethasone 4 mg , and placebo every eight hours as prophylaxis for acute mountain sickness during rapid , active ascent of Mount Rainier ( elevation 4,392 m ) . Forty-two subjects ( 89.4 percent ) achieved the summit in an average of 34.5 hours after leaving sea level . At the summit or high point attained above base camp , the group taking dexamethasone reported less headache , tiredness , dizziness , nausea , clumsiness , and a greater sense of feeling refreshed ( p less than or equal to 0.05 ) . In addition , they reported fewer problems of runny nose and feeling cold , symptoms unrelated to acute mountain sickness . The acetazolamide group differed significantly ( p less than or equal to 0.05 ) from other groups at low elevations ( 1,300 to 1,600 m ) , in that they experienced more feelings of nausea and tiredness , and they were less refreshed . These drug side effects probably obscured the previously established prophylactic effects of acetazolamide for acute mountain sickness . Separate analysis of an acetazolamide subgroup that did not experience side effects at low elevations revealed a prophylactic effect of acetazolamide similar in magnitude to the dexamethasone effect but lacking the euphoric effects of dexamethasone . This study demonstrates that prophylaxis with dexamethasone can reduce the symptoms associated with acute mountain sickness during active ascent and that acetazolamide can cause side effects that may limit its effectiveness as prophylaxis against the disease

Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history

PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft

Abstract . This study documented postoperative morbidity during the first 4 months following anterior cruciate ligament ( ACL ) reconstruction using either patellar tendon or hamstring tendon autograft . Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction were r and omized to have a central third bone patellar tendon bone autograft ( PT ) or a doubled semitendinosus/doubled gracilis autograft ( HS ) . Postoperatively patients undertook a st and ard ' accelerated ' rehabilitation protocol . Patients were review ed after 2 weeks , 8 weeks , and 4 months . At each review the location and severity of general knee pain and the presence and severity of anterior knee pain ( AKP ) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb . Pain on kneeling , KT-1000 measured side to side difference in anterior tibial displacement , isokinetic assessment of quadriceps and hamstring peak torque deficits , IKDC score and Cincinnati sports activity level were also recorded after 4 months . After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe . After 8 weeks there was no significant difference between the groups for any variable . After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group . The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 ° /s . IKDC scores were higher in the HS group , but Cincinnati sports activity scores were higher in the PT group . Although we observed a lower morbidity in the HS group , primarily related to pain , the severity of pain in both groups was relatively low and , in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial.

BACKGROUND There are no controlled , prospect i ve studies comparing the 10-year outcomes of anterior cruciate ligament ( ACL ) reconstruction using patellar tendon ( PT ) and 4-str and hamstring tendon ( HT ) autografts . HYPOTHESIS Comparable results are possible with HT and PT autografts . STUDY DESIGN Cohort study ; Level of evidence , 2 . METHODS One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction ( 90 HT autograft , 90 PT autograft ) by one surgeon and were treated with an accelerated rehabilitation program . All knees were observed in a prospect i ve fashion with subjective , objective , and radiographic evaluation at 2 , 5 , 7 , and 10-year intervals . RESULTS At 10 years , there were no differences in graft rupture rates ( 7/90 PT vs. 12/90 HT , P = .24 ) . There were 20 contralateral ACL ruptures in the PT group , compared with 9 in the HT group ( P = .02 ) . In all patients , graft rupture was associated with instrumented laxity > 2 mm at 2 years ( P = .001 ) . Normal or near-normal function of the knee was reported in 97 % of patients in both groups . In the PT group , harvest-site symptoms ( P = .001 ) and kneeling pain ( P = .01 ) were more common than in the HT group . More patients reported pain with strenuous activities in PT knees than in HT knees ( P = .05 ) . Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees ( P = .04 ) . The difference , however , was composed of patients with mild osteoarthritis . Other predictors of radiographic osteoarthritis were < 90 % single-legged hop test at 1 year and the need for further knee surgery . An " ideal " outcome , defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction , was associated with <3 mm of instrumented laxity at 2 years , the absence of additional surgery in the knee , and HT grafts . CONCLUSIONS It is possible to obtain excellent results with both HT and PT autografts . We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Comparison of Kneelax and KT-1000 knee ligament arthrometers.

Two commercially available knee ligament arthrometers ( KT-1000 MEDmetric Corporation , San Diego , California and Kneelax MR Systems , Haarlem , The Netherl and s ) were used to measure anterior tibial translation . In this study 91 subjects with no history of knee pathology were tested using both devices . Both normal knees were tested and comparison of recorded anterior translation ( millimeters ) was performed . Absolute numbers at forces of 67N , 89N , 134N , and manual maximum displacements were recorded . Side-to-side differences were calculated and data were compared . There was a significant difference found between the absolute values of each device . The KT-1000 was found to record greater values in millimeters of translation . Although the absolute values were significantly different , the side-to-side differences were not significantly different between devices

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction

Background : Numerous studies have compared patellar tendon ( PT ) and hamstring tendon ( HS ) anterior cruciate ligament ( ACL ) reconstructions in the short to midterm , but fewer long-term results have been published . Hypothesis : There will be no difference in functional outcome between ACL reconstruction performed with PT and HS grafts , but PT grafts will have more donor site morbidity . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Sixty-five patients undergoing ACL reconstruction were r and omized to receive either a PT graft or a 4-str and HS graft . Early results were reported at 4 , 8 , 12 , 24 , and 36 months . Forty-seven patients ( 22 of 31 PT and 25 of 34 HS ) were review ed at a mean of 15.3 years . Results : Four graft ruptures ( 1 PT , 3 HS ) and 6 contralateral ACL injuries ( 4 PT , 2 HS ) occurred in the group that was review ed . There was no statistically significant difference between the groups for any of the variables measured . There was a similar incidence of anterior knee pain and kneeling pain in both groups . The previously observed increased extension deficit in the PT group at 3 years was not present at 15 years , and there was no significant between-group difference in knee laxity . A higher proportion of patients in the PT group were participating in sport on a weekly basis ( 73 % PT , 48 % HS ; P = .05 ) . There was no difference in the degree of osteoarthritis between the groups . Conclusion : This r and omized controlled trial showed that HS and PT ACL reconstructions have comparable results at an average 15-year follow-up . Contrary to the study hypothesis , some of the graft differences seen at earlier review were not present at 15 years , and patients with PT grafts were more active in sport participation . Overall , both graft types provided good long-term subjective and objective outcomes

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Long-term Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A 17-Year Follow-up of a Randomized Controlled Trial

Background : Short-term and mid-term differences between hamstring and patellar tendon autografts for anterior cruciate ligament ( ACL ) reconstruction are well documented . Systematic review s highlight the lack of long-term results between the two grafts . Hypothesis : Seventeen years after ACL reconstruction , no difference will be found in functional outcome , quality of life , and graft failure between patients with patellar tendon ( PT ) or semitendinosus and gracilis tendon ( STG ) autografts ; however , a significant difference will be seen in the prevalence of osteoarthritis . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Sixty-four patients were included in this prospect i ve study ( 32 in each group ) . A single surgeon performed primary ACL reconstruction in alternating sequence . Forty-eight patients ( 24 in each group ) were evaluated 17 years after ACL reconstruction : A clinical assessment was made based on the International Knee Documentation Committee ( IKDC ) form , instrumented laxity was measured with KT-1000 arthrometer , and radiography of the operated knee was conducted and assessed for degenerative disease . The Lysholm question naire and the Short Form–36 version 2 question naire were filled out by the patients . Results : At the 17-year follow-up , no statistically significant differences were seen with respect to graft failure ( 2 reruptures in the semitendinosus and gracilis tendon [ STG ] group [ 6.3 % ] and 3 reruptures in the PT group [ 9.4 % ] ) and functional outcome . Increased instrumented laxity ( > 3 mm ) measured with KT-1000 arthrometer was seen in significantly more patients in the STG group ( 8 in the STG group compared with 2 in the PT group ; P = .03 ) with a mean side-to-side difference of 2.17 ± 1.86 mm in the STG group compared with 1.33 ± 1.93 mm in the PT group . A significant difference was found in frequency of knee osteoarthritis (OA)—100 % in the PT group compared with 71 % in the STG group ( P = .004 ) . Patients in the PT group tended to have higher grade OA according to the IKDC grading system , with an average grade of 1.46 in the PT group compared with 1 in the STG group ( P = .055 ) . The degenerative changes in the PT group were more common in the medial and patellofemoral compartments ( P = .003 and P = .04 , respectively ) . Conclusion : Both autografts provided good to excellent subjective outcomes . No significant differences were noted in graft failure and clinical instability . However , significantly more patients in the STG group had increased instrumented anteroposterior translation measured with KT-1000 arthrometer , and there was a greater prevalence of knee OA at 17 years after surgery in the PT group

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Assessment of Differences Between the Modified Cincinnati and International Knee Documentation Committee Patient Outcome Scores

Background Functional outcome question naires have become a common part of patient follow-up in the orthopaedic community . The modified Cincinnati Knee Rating System and the International Knee Documentation Committee ( IKDC ) subjective scale were design ed to provide clinicians with information regarding a patient ’s functional and clinical status after knee surgery . Hypothesis The functional outcome data reported on the modified Cincinnati Knee Rating System and the IKDC subjective question naire are equivalent . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods Between 2000 and 2007 , all patients with complex knee disorders seen in our orthopaedic clinic were prospect ively followed and given simultaneously the modified Cincinnati Knee Rating System and the IKDC subjective question naires to report their functional outcomes . The total scores of each instrument were compared at each time of evaluation . As a measure of responsiveness , the st and ardized response means were calculated . A second within-patient analysis was also performed to determine if the results would be different when looked at by the patient . Results There were a total of 130 patients with a total of 444 modified Cincinnati Knee Rating System question naires and 462 IKDC subjective complete question naires included in the study . Overall total scores on both the modified Cincinnati Knee Rating System and the IKDC subjective question naires were equivalent in a population analysis . Overall total scores showed improvement in function over time from preoperative measurement through the 2-year follow-up . The individual patient analysis demonstrated that , for a specific patient , it was possible that up to 34 % of the population would report a total score of more than 10 points difference , depending on the scale selected . Conclusion The modified Cincinnati Knee Rating System and the IKDC subjective rating question naires reported by patient population provide similar results . The practitioner who is not performing a population -based study but following individual patients for recovery will find that the individual question naires may offer different functional limitations . Individual differences were lost in the population means , with the approximate balance of positive and negative score differences masking the individual patient differences

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Anterior Cruciate Ligament Revision Surgery: Ipsilateral Quadriceps Versus Contralateral Semitendinosus-Gracilis Autografts.

PURPOSE To evaluate the subjective outcomes , knee stability , and donor-site morbidity after revision ACL reconstruction using either autologous ipsilateral quadriceps tendon or contralateral semitendinosus-gracilis tendon . METHODS A sample size calculation suggested that we needed 25 patients in each group to detect e quality between both groups . Therefore , we evaluated 30 consecutive patients who underwent an ACL revision surgery with ipsilateral bone-quadriceps tendon grafts and 30 consecutive patients with the contralateral semitendinosus-gracilis grafts between January 2010 and December 2012 . Because of follow-up and exclusion criteria , finally 51 patients were evaluated . All patients were followed prospect ively for at least 2 years with KT1000 arthrometer testing and the International Knee Documentation Committee ( IKDC ) objective grading . At the 24-month follow-up , additional clinical scores were evaluated : the Knee Injury Osteoarthritis Outcome Score ( KOOS ) , the Lysholm score , assessing pain during kneeling , and anterior knee pain . RESULTS The KT1000 postoperative arthrometer side-to-side difference was 2.0 ± 1.2 mm for the quadriceps group and 3.0 ± 2.9 mm for the semitendinosus-gracilis group . The difference was not statistically significant ( P = .461 ) . There was also no difference in the rate of positive pivot-shift tests between groups ( P = .661 ) . The Lysholm score was 82.5 ± 18 in the quadriceps group and 73.8 ± 19 in the semitendinosus-gracilis group . The difference was not statistically significant ( P = .060 ) . There was also no significant difference in the single KOOS subscores , assessing pain while kneeling and anterior knee pain ( included in the KOOS score ) . No rerupture occurred during follow-up . CONCLUSIONS Revision ACL reconstruction using the quadriceps tendon graft showed clinical outcomes similar to those of the contralateral semitendinosus-gracilis graft in terms of knee stability and function . Thus , the bone-quadriceps tendon graft may be a good alternative to the contralateral semitendinosus-gracilis tendon graft for revision ACL reconstruction . LEVEL OF EVIDENCE Level II , prospect i ve comparative study

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods

ACL reconstruction with bone patellar tendon bone ( BPTB ) grafts has been shown to produce dependable results . Recently , reconstructions with double-looped semitendinosus gracilis ( DLSG ) grafts have become common . The prevailing opinion is that ACL reconstruction with patellar tendon graft produces a more stable knee with more anterior knee pain than DLSG grafts , while the functional results and knee scores are similar . The present study evaluates BPTB grafts fixed with metallic interference screws and DLSG grafts fixed with Bone Mulch Screw on the femur and WasherLoc fixation on the tibia . All else being the same , there is no difference in the outcome between the two grafts and fixation methods . This is a prospect i ve r and omized multicenter study . A total of 115 patients with isolated ACL ruptures were r and omized to either reconstruction with BPTB grafts fixed with metal interference screws ( 58 patients ) or DLSG grafts ( 57 patients ) fixed with Bone Mulch Screws and WasherLoc Screws . Follow-up was at one and two years ; the latter by an independent observer . At two years , one ACL revision had been performed in each group . Eight patients in the DLSG group and one in the BPTB group underwent meniscus surgery in the follow-up period ( P = 0.014 ) . Mean Lysholm score at the two year follow-up was 91 ( SD ± 10.3 ) in the DLSG group and also 91 ( SD ± 10.2 ) in the BPTB group . Mean KT-1000 at two years was 1.5 mm in the BPTB group and 1.8 mm in the DLSG group ( n.s . ) . At two years , four patients in the BPTB group and three in the DLSG group had a Lachman test grade 2 or 3 ( n.s . ) . More patients in the BPTB group had pain at the lower pole of the patella ( P = 0.04 ) . Peak flexion torque and total flexion work were lower in the DLSG group at one year ( P = 0.003 and P = 0.000 ) and total flexion work also at two years ( P = 0.05 ) . BPTB ACL reconstruction fixed with interference screws and DLSG fixed with Bone Mulch Screws on the femur and WasherLoc Screws on the tibia produce satisfactory and nearly identical outcomes . Among our patients in the DLSG group , flexion strength was lower , and more patients underwent meniscus surgery in the follow-up period . The BPTB group has more anterior knee pain

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

Purpose Graft choice for anterior cruciate ligament ( ACL ) reconstruction is crucial , however the optimal graft source remains a topic of controversy . The purpose of this study is to compare subjective and functional patient-reported outcomes ( PRO ) after single-bundle ACL reconstruction using quadriceps tendon ( QT ) or hamstring tendon ( HT ) autografts for single-bundle ACL reconstruction . We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft . Methods All data were extracted from a prospect ively collected ACL registry . A total of 80 patients with at least 2-year follow-up were included in this study . A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex , age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts . Subjective and functional PRO scores including Lysholm score , Tegner activity level and visual analogue scale for pain were obtained at 6 , 12 and 24 months after index surgery . Results No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain . 24 months post-surgery the mean Tegner activity score of the HT group was significantly ( p = 0.04 ) lower compared to the pre-injury status . At final follow-up , 27 patients ( 67.5 % ) in the QT group and 32 patients ( 80.0 % ) in the HT returned to their pre-injury activity level ( n.s . ) . A total of 37 patients ( 92.5 % ) of the QT cohort and 35 patients ( 87.5 % ) of the HT cohort reported “ good ” or “ excellent ” results according to the Lysholm score ( n.s . ) . “ No pain ” or “ slight pain ” during severe exertion was reported by 33 patients ( 82.5 % ) with QT autograft and 28 patients ( 82.4 % ) with HT autograft ( n.s . ) . Conclusion There is no significant difference between PRO 2 years post-operative using either QT or HT autografts . Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction . Level of evidence III

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: A randomized controlled trial.

BACKGROUND The comparison between HT and QT grafts in strength recovery and function after an ACLR is scarce in the literature . METHODS A total of 56 participants were enrolled in this r and omized controlled trial and placed into two groups : HT or QT . The hamstring/quadriceps ( H/Q ) ratio was the primary end-point measured with a Genu-3 dynamometer . Peak torque , functional assessment ( Lysholm knee scoring scale and Cincinnati Knee Rating System ) , and anteroposterior laxity ( KT-2000 ™ arthrometer ) were also assessed . An intention-to-treat analysis was performed . RESULTS The results of the H/Q ratio analysis of the participants over time revealed significant differences at 60 , 180 , and 300 ° /s at three , six , and 12months of follow-up ( 60 ° /s : F=5.3 , p=0.005 ; 180 ° /s : F=5.5 , p=0.004 ; 300 ° /s : F=5.1 , p=0.005 ) . Furthermore , they revealed significant differences at 60 ° /s , 180 ° /s , and 300 ° /s in the participants over time for peak torque in the extensor muscle strength at three and six months of follow-up , with higher values in the hamstring tendon group but not at 12months of follow-up . There were no significant differences in functional endpoints or arthrometer assessment s at 24months of follow-up . CONCLUSION An ACLR with a QT graft showed similar functional results with a better isokinetic H/Q ratio compared to an ACLR with the HT at 12months of follow-up in soccer players . This higher H/Q ratio observed with the QT could be an advantage of this graft over the HT for an ACLR

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

A Randomized Clinical Trial Comparing Patellar Tendon, Hamstring Tendon, and Double-Bundle ACL Reconstructions: Patient-Reported and Clinical Outcomes at a Minimal 2-Year Follow-up

Objective : To compare 3 anatomically positioned autografts for anterior cruciate ligament ( ACL ) reconstruction , by measuring patient-reported disease-specific quality of life at 2 years postoperatively . Design : Double-blinded , r and omized clinical trial with intraoperative computer-generated treatment allocation . Patients and an independent trained evaluator were blinded . Setting : University-based orthopedic referral practice . Patients : Three hundred thirty patients ( 14 - 50 years ; 183 male patients ) with isolated ACL deficiency were equally r and omized to : ( 1 ) patellar tendon , PT : 28.7 years ( SD = 9.7 ) ; ( 2 ) quadruple-str and ed hamstring tendon , HT : 28.5 years ( SD = 9.9 ) ; and ( 3 ) double bundle using HT , DB : 28.3 years ( SD = 9.8 ) ; 322 patients completed 2-year follow-up . Intervention : Anterior cruciate ligament reconstruction using PT , HT , or DB autografts . Main Outcome Measures : Measured at baseline , 1 and 2 years postoperatively— primary : anterior cruciate ligament quality -of-life scores ; secondary : International Knee Documentation Committee ( IKDC ) scores , KT-1000 arthrometer , pivot shift , range of motion , Tegner activity , Cincinnati Occupational Scale , and single-leg hop . Proportions of correct graft type guesses by the patients and evaluator assessed blinding effectiveness . Results : Baseline characteristics were not different . Anterior cruciate ligament quality -of-life scores increased over time for all groups ( P = 0.001 ) but were not different at 2 years ( P = 0.591 ) : PT = 84.6 ( SD = 16.6 , 95 % confidence interval [ CI ] = 81.4 - 87.8 ) , HT = 82.5 ( SD = 17.7 , 95 % CI = 79.2 - 85.9 ) , and DB = 82.4 ( SD = 17.5 , 95 % CI = 79.1 - 85.7 ) . Two-year KT-1000 side-to-side differences ( PT = 1.86 mm ; HT = 2.97 mm ; DB = 2.65 mm ) were statistically significant between PT – HT ( P = 0.002 ) and PT – DB ( P = 0.044 ) . The remaining secondary outcomes were not statistically different . Correct graft type guesses occurred 51 % of the time for patients and 46 % for the evaluator . Conclusions : Two-year disease-specific quality -of-life outcome was not different between the ACL reconstruction techniques . The PT reconstructions had significantly lower side-to-side differences on static stability measures . Patient and evaluator blinding was achieved . Level of Evidence : Level 1 ( Therapeutic Studies ) . Clinical Relevance : This high- quality , large , double-blind r and omized clinical trial ( RCT ) addresses the insufficient evidence in the literature comparing PT , single-bundle hamstring , and DB hamstring reconstructions for ACL rupture in adults . In addition to the clinical and functional results , this RCT uniquely reports on the disease-specific , patient-reported quality -of-life outcome at 2 years postoperatively

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up.

BACKGROUND The aim of the study was to compare the results after arthroscopic anterior cruciate ligament ( ACL ) reconstruction using central -third bone-patellar tendon-bone ( BTB ) autografts and triple/quadruple semitendinosus ( ST ) autografts . HYPOTHESIS In the long-term , ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts . STUDY DESIGN R and omized controlled trial ; Level of evidence , 1 . METHODS A r and omized series of 71 patients ( 22 women and 49 men ) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study . The BTB graft was used in 34 patients ( BTB group ) and the ST-tendon graft was used in 37 patients ( ST group ) . The patients were examined a median of 86 months ( range , 68 to 114 months ) after the reconstruction . RESULTS Sixty-eight of 71 patients ( 96 % ) were examined at follow-up . The clinical assessment s at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score , Tegner activity level , International Knee Documentation Committee evaluation system , 1-legged hop test , KT-1000 arthrometer laxity measurements , manual Lachman test , and range of motion . A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessment s. Donor-site morbidity in the form of knee-walking ability , kneeling ability , and area of disturbed anterior knee sensitivity revealed no significant differences between the groups . CONCLUSION Seven years after ACL reconstruction , the subjective and objective outcomes were similar after using the central -third BTB autograft and triple/quadruple ST autograft . Furthermore , no difference in terms of donor-site morbidity was found between the 2 groups

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

[Hamstring versus quadriceps tendon graft in double-bundle anterior cruciate ligament reconstruction].

PURPOSE OF THE STUDY The aim of this prospect i ve study was to evaluate functional outcomes and knee joint stability after double-bundle anterior cruciate ligament reconstruction using three-tunnel quadriceps tendon-bone graft and four-tunnel hamstring graft ( semi-tendinosus and gracilis muscles ) . MATERIAL Group 1 included 20 patients undergoing reconstruction with quadriceps tendon- bone graft group ; 2 comprised of 20 patients treated by hamstring graft . There were 26 men and 14 women , with an average age of 27 ( range , 16 to 44 ) years . The minimum follow-up period was one year . METHODS In group 1 patients , semi-anatomic anterior cruciate ligament reconstruction was performed by a three-tunnel technique ( two tunnels in the femur and one in the tibia ) using quadriceps femoris muscle graft . Group 2 patients were treated by anatomic four-tunnel reconstruction ( two tunnels in the femur and two in the tibia ) with the use of hamstring graft . Functional outcomes were evaluated on the basis of Lysholm and IKDC scores . Antero-posterior stability was measured with aKT-1000 arthrometer and rotational stability was assessed by the pivot-shift test . For statistical evaluation , the level of significance ( p ) was set at < 0.05 . RESULTS The final evaluation showed an average Lysholm score of 88.9 ± 12 ( 76 - 100 ) points for group 1 , and 87.9 ± 11 ( 62 - 100 ) points for group 2 ; there was no statistically significant difference . The rounded average result of the functional IKDC score after surgery was the same in the two groups ( 80 ± 10 ) . The joints treated by the three-tunnel technique had on average better antero-posterior stability , but this was not statistically significant . The pivot-shift phenomenon was not seen in either of the groups . Operative times in both groups were comparable . An intra-operative fracture of the patella occurred in two patients of group 1 . DISCUSSION No similar prospect i ve study comparing the outcomes of the methods reported here has been found in the internatio- nal literature . The studies so far published have not included any such comparison or they compared other techniques , such as single- versus double-bundle reconstructions . CONCLUSIONS Based on Lysholm and IKDC score evaluation and antero-posterior and rotational stability assessment , it can be concluded that both the three- and the four-tunnel technique of anterior cruciate ligament reconstruction gave similar results , with no significant differences , at one-year follow-up . However , these are only short-term results and only a long-term follow-up can prove or disprove the validity of this conclusion

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial.

BACKGROUND The choice of graft for anterior cruciate ligament reconstruction is a matter of debate , with patellar and hamstring tendons being the two most popular autologous graft options . The objective of this study was to determine in a prospect i ve , r and omized clinical trial whether two grafts ( bone-patellar tendon-bone or doubled hamstring tendons ) fixed with modern devices affect the two-year minimum clinical and radiographic outcomes of anterior cruciate ligament reconstruction . METHODS One hundred and twenty patients with a chronic unilateral rupture of the anterior cruciate ligament underwent arthroscopically assisted reconstruction with use of either autologous bone-patellar tendon-bone or doubled hamstring tendon grafts , in a strictly alternating manner . Both groups were comparable with regard to demographic data , preoperative activity level , mechanism of injury , interval between the injury and the operation , and the amount of knee laxity present preoperatively . The same well-proven surgical technique and aggressive controlled rehabilitation was used . An independent observer , who was blinded with regard to the involved leg and the type of graft , performed the outcome assessment with use of a visual analog scale , the new International Knee Documentation Committee form , the Knee Injury and Osteoarthritis Outcome Score , the Functional Knee Score for Anterior Knee Pain , and an arthrometric and an isokinetic dynamometric evaluation . Radiographs were also made . RESULTS At the two-year follow-up evaluation , no differences were found in terms of the visual analog score , the Knee Injury and Osteoarthritis Outcome Score , the new International Knee Documentation Committee subjective and objective evaluation scores , the KT-1000 side-to-side laxity measurements , the Functional Knee Score for Anterior Knee Pain , muscle strength recovery , or return to sports activities . In the bone-patellar tendon-bone group , we found a higher prevalence of postoperative kneeling discomfort ( p < 0.01 ) and an increased area of decreased skin sensitivity ( p < 0.001 ) . In the hamstring tendon group , we recorded a higher prevalence of femoral tunnel widening ( p < 0.01 ) . In this group , a correlation was also found between medial meniscectomy and an increased prevalence of pivot-shift glide ( p = 0.035 ) . CONCLUSIONS We believe that , with use of accurate and proven surgical and rehabilitation techniques , both grafts are an equivalent option for anterior cruciate ligament reconstruction

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers

Purpose The purpose of this article was to demonstrate an anterior cruciate ligament ( ACL ) reconstruction technique using oval tunnels . Aim of this single bundle technique is to fit the footprint anatomy of the ACL as closely as possible . Technique and patients The presented technique is a single bundle technique using a semitendinosus graft . For femoral tunnel placement , a specific medial portal aim er ( Karl Storz , Tuttlingen , Germany ) is used . Aim ing and drilling of the femoral tunnel are performed via the medial portal . Oval tunnels are created by stepwise dilatation with ovally shaped dilatators . The position of the femoral tunnel is visualized and controlled with the arthroscope via the medial portal . For the tibial tunnel placement , a specific aim er was used as well . With this technique , 24 patients were operated and all intra- and postoperative complications were analyzed prospect ively . The tunnel position was documented postoperatively by CT scan . Results There were no significant intra- and postoperative complications associated with the oval tunnel technique . The postoperative 3D CT scan revealed that all femoral and tibial tunnels were located within the area of the anatomical ACL insertions . Conclusions This article presents an ACL reconstruction technique using oval dilatators and medial portal aim ers to create oval tunnels . These oval tunnels match the insertion site anatomy much closer than round tunnels do . Level of Evidence Level IV , case series

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years

Background : The quadriceps tendon ( QT ) autograft is known as an effective graft for anterior cruciate ligament ( ACL ) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone ( BPTB ) in r and omized controlled trials , with a lesser incidence of complications . Up until now , only 2 studies have compared QT to hamstring tendon ( HT ) autograft . Hypothesis : The functional outcomes of the QT technique are at least as good as those of the HT technique , with the same morbidity . Study Design : Cohort study ; Level of evidence , 3 . Methods : Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31 , 2012 . Fifty underwent ACL reconstruction with the QT and 45 with the HT . The same surgical technique , fixation method , and postoperative protocol were used in both groups . The following parameters were evaluated : surgical revisions , functional outcome ( Lysholm , Knee injury and Osteoarthritis Outcome Score [ KOOS ] , Tegner , subjective International Knee Documentation Committee ) , joint stability ( KT-1000 , Lachman , pivot shift ) , anterior knee pain ( Shelbourne-Trumper score ) , and isokinetic strength . Descriptive statistics are presented for these variables using the Student t test . Results : Eighty-six patients ( 45 QT , 41 HT ) were review ed with a mean follow-up of 3.6 ± 0.4 years ; minimum follow-up was 3 years . There were 4 reoperations in the QT group ( including 1 ACL revision ) and 3 in the HT group ( including 2 ACL revisions ) ( P > .05 ) . The Lysholm ( 89 ± 6.9 vs 83.1 ± 5.3 ) , KOOS Symptoms ( 90 ± 11.2 vs 81 ± 10.3 ) , and KOOS Sport ( 82 ± 11.3 vs 67 ± 12.4 ) scores were significantly better in the QT group than in the HT group . In terms of stability , the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005 ) . The negative Lachman component was higher in the QT group than in the HT group ( 90 % vs 46 % , P < .005 ) . There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group ( 90 % vs 64 % , P = .052 ) . The Shelbourne-Trumper score was the same in both groups . There was no difference between groups in terms of isokinetic strength . Conclusion : The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft , without affecting morbidity

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up.

PURPOSE To analyze the long-term evaluation of clinical , functional , and magnetic resonance imaging ( MRI ) results after implant-free press-fit anterior cruciate ligament ( ACL ) reconstruction with bone-patella tendon ( BPT ) versus quadrupled hamstring tendon ( HT ) grafts . METHODS Sixty-two ACL-insufficient patients were included in a prospect i ve , r and omized study ( 31 BPT and 31 HT ) . Both surgical procedures were performed without any implants by a press-fit technique by the senior author . The femoral tunnel was drilled through the anteromedial portal for anatomic placement . At 8.8 years after reconstruction , 53 patients ( 28 BPT and 25 HT ) were examined by different clinical and functional tests . Bilateral MRI scans were performed and interpreted by an independent radiologist . RESULTS On follow-up , the score on the International Knee Documentation Committee evaluation form was significantly better in the HT group . The clinical examination including range of motion , KT-1000 test ( MEDmetric , San Diego , CA ) , and pivot-shift test showed no significant differences . On isokinetic testing , the mean quadriceps strength was close to normal ( 96 % ) in both groups , but the hamstring strength was lower in the HT group ( 100.3%/95.1 % ) . Kneeling ( 1.5/1.1 , P = .002 ) , knee walking ( 1.72/1.14 , P = .002 ) , and single-leg hop test ( 95.8%/99.1 % , P = .057 ) were better in the HT group . The MRI findings about the mean degree of cartilage lesion ( International Cartilage Repair Society protocol ) of the operated ( 2.1/2.1 ) and nonoperated ( 1.4/1.8 ) knee showed no significant differences . No significant difference was found in the grade of medial or lateral meniscal lesion or the number of patients having meniscal lesions when the operated and nonoperated knees were compared . Tunnel measurements , Caton-Deschamps Index , and the sagittal ACL angle were similar . CONCLUSIONS The implant-free press-fit technique for anterior cruciate ligament reconstruction by use of bone-patellar tendon and hamstring grafts with anatomic graft placement is an innovative technique to preserve the cartilage and meniscal status without significant differences between the operated and nonoperated knees in the long term . Significantly less anterior knee pain was noted in the hamstring group , when testing for kneeling and knee walking . LEVEL OF EVIDENCE Level II , prospect i ve comparative study

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction *

Background Patellar and hamstring tendon autografts are the most frequently used graft types for anterior cruciate ligament reconstruction , but few direct comparisons of outcomes have been published . Hypothesis There is no difference in outcome between the two types of reconstruction . Study Design Prospect i ve r and omized clinical trial . Methods After isolated anterior cruciate ligament rupture , 65 patients were r and omized to receive either a patellar tendon or a four-str and hamstring tendon graft reconstruction , and results were review ed at 4 , 8 , 12 , 24 , and 36 months . Results Pain on kneeling was more common and extension deficits were greater in the patellar tendon group . There were greater quadriceps peak torque deficits in the patellar tendon group at 4 and 8 months but not thereafter . In the hamstring tendon group , active flexion deficits were greater from 8 to 24 months , and KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N were greater . Cincinnati knee scores , International Knee Documentation Committee ratings , and rates of return to preinjury activity levels were not significantly different between the two groups . Conclusions Both grafts result ed in satisfactory functional outcomes but with increased morbidity in the patellar tendon group and increased knee laxity and radiographic femoral tunnel widening in the hamstring tendon group

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study.

PURPOSE The purpose of this r and omized controlled study was to compare knee stability , kneeling pain , harvest site pain , sensitivity loss , and subjective clinical outcome after primary anterior cruciate ligament ( ACL ) reconstruction with either bone-patellar tendon-bone ( BPTB ) or quadriceps tendon-bone ( QTB ) autografts in a noninferiority study design . METHODS From 2005 to 2009 , a total of 51 patients were included in the present study . Inclusion criteria were isolated ACL injuries in adults . Twenty-five patients were r and omized to BPTB grafts and 26 to QTB grafts . An independent examiner performed follow-up evaluations 1 and 2 years postoperatively . Anteroposterior knee laxity was measured with a KT-1000 arthrometer ( MEDmetric , San Diego , CA ) . Anterior knee pain was assessed clinical ly and by knee-walking ability . Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and subjective International Knee Documentation Committee ( IKDC ) score were used for patient-evaluated outcome . RESULTS Anterior knee laxity was equal between the 2 groups with KT-1000 values of 1.1 ± 1.4 mm and 0.8 ± 1.7 mm st and ard deviation ( SD ) at follow-up in QTB and BPTB groups , respectively ( P = .65 ) , whereas positive pivot shift test results were seen less frequently ( 14 % compared with 38 % , respectively ; P = .03 ) . Anterior kneeling pain , evaluated by the knee walking ability test , was significantly less in the QTB group , with only 7 % of patients grading knee walking as difficult or impossible compared with 34 % in the BPTB group . At 1 and 2 years ' follow-up , there was no difference between the 2 groups in subjective patient-evaluated outcome . The IKDC score was 75 ± 13 patients and 76 ± 16 SD at 1-year follow-up in QTB and BPTB groups , respectively ( P = .78 ) . At 2 years , 12 patients were lost to follow-up , result ing in 18 in the BPTB group and 21 in the QTB group . CONCLUSIONS The use of the QTB graft results in less kneeling pain , graft site pain , and sensitivity loss than seen with BPTB grafts ; however , similar anterior knee stability and subjective outcomes are seen . The results of this study show that QTB is a viable option for ACL reconstruction . LEVEL OF EVIDENCE Level II , r and omized controlled clinical trial

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Knee laxity after staircase exercise predicts radiographic disease progression in medial compartment knee osteoarthritis.

OBJECTIVE To evaluate whether increased laxity of the knee during daily physical activities such as stair climbing is associated with progression of knee joint osteoarthritis ( OA ) . METHODS During the years 2001 - 2003 , 136 patients with bilateral primary medial compartment knee joint OA were enrolled in this prospect i ve study . Baseline data collected were body mass index ( BMI ) , muscle power , radiographic joint space width , mechanical axis on st and ing radiography , and anteroposterior ( AP ) knee laxity before and after physical exercise . After 8 years of followup , 84 patients were reexamined to assess radiographic changes . Radiographic disease progression was defined as progression of > 1 grade on the Kellgren/Lawrence scale . RESULTS AP knee laxity increased significantly after stair climbing . Patients with OA progression and those without progression did not differ significantly in age , sex , baseline quadriceps muscle strength , mechanical axis , joint space width , and AP knee laxity before exercise . The 2 groups of patients did , however , differ significantly in baseline BMI and change in AP knee laxity due to exercise . The risk of progression of knee OA increased 4.15-fold with each millimeter of increase in the change in AP knee laxity due to exercise and 1.24-fold with each point increase in the BMI . CONCLUSION Our results indicate that patients with OA progression have significantly greater changes in knee joint laxity during physical activities and a higher BMI than patients without OA progression . These findings suggest that larger changes in knee laxity during repetitive physical activities and a higher BMI play significant roles in the progression of knee OA

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

Patellar Tendon Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction

Background Controversy remains over the most appropriate graft for anterior cruciate ligament reconstruction . Hypothesis There is no significant difference in outcomes after 4-str and hamstring and patellar tendon autograft anterior cruciate ligament reconstructions using similar fixation techniques . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Between August 2000 and May 2003 , 64 Keller Army Hospital patients with complete anterior cruciate ligament tears were r and omized to hamstring ( n = 32 ) or patellar tendon ( n = 32 ) autograft anterior cruciate ligament reconstruction . Operative graft fixation and rehabilitative techniques were the same for both groups . Follow-up assessment s included the Single Assessment Numeric Evaluation score , Lysholm score , International Knee Documentation Committee score , and Knee Injury and Osteoarthritis Outcome Score . Postoperative radiographs were analyzed for tunnel location and orientation . Results Eleven women and 53 men were r and omized . Eighty-three percent of the patients ( 53 of 64 ) had follow-up of greater than 2 years , or to the point of graft rupture or removal ( average follow-up , 36 months ) . Four hamstring grafts ( 12.5 % ) and three patellar tendon grafts ( 9.4 % ) ( P = .71 ) ruptured . One deep infection in a hamstring graft patient necessitated graft removal . Forty-five of the 56 patients with intact grafts had greater than 2-year follow-up . Patients with patellar tendon grafts had greater Tegner activity scores ( P = .04 ) . Single Assessment Numeric Evaluation scores were 88.5 ( 95 % confidence interval : 83.1 , 93.8 ) and 90.1 ( 95 % confidence interval : 85.2 , 96.1 ) for the hamstring and patellar tendon groups , respectively ( P = .53 ) . Lysholm scores were 90.3 ( 95 % confidence interval : 84.4 , 96.1 ) and 90.4 ( 95 % confidence interval : 84.5 , 96.3 ) for the hamstring and patellar tendon groups , respectively ( P = .97 ) . There were no significant differences in knee laxity , kneeling pain , isokinetic peak torque , International Knee Documentation Committee score , or Knee Injury and Osteoarthritis Outcome Scores . Postoperative graft rupture correlated with more horizontal tibial tunnel orientation . Conclusion Hamstring and patellar tendon autografts provide similar objective , subjective , and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction

The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction .

The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects.

OBJECTIVES To investigate the effects of darifenacin controlled-release ( CR ) and oxybutynin extended-release ( ER ) on cognitive function ( particularly memory ) in older subjects . METHODS Healthy subjects ( n=150 ) > /=60 years were r and omised to darifenacin , oxybutynin ER or placebo in a multicentre , double-blind , double-dummy , parallel-group , 3-week study . Doses were administered according to US labels : oxybutynin ER 10 mg once daily ( od ) , increasing to 15 mg od then 20 mg od by week 3 ; darifenacin 7.5 mg od in weeks 1 and 2 , then 15 mg od in week 3 . The primary end point was accuracy on the Name-Face Association Test ( delayed recall ) at week 3 . RESULTS Results of the Name-Face Association Test at week 3 showed no significant difference between darifenacin and placebo on delayed recall ( mean difference , -0.06 , p=0.908 ) . In contrast , oxybutynin ER result ed in memory impairment , with significantly lower scores than placebo and darifenacin ( mean differences , -1.30 , p=0.011 and -1.24 , p=0.022 , respectively ) for delayed recall on the Name-Face Association Test at week 3 . Additional tests of delayed recall indicated significant memory impairment with oxybutynin ER versus placebo at certain time points , whereas darifenacin was similar to placebo . No between-treatment differences were detected in self-rated memory , demonstrating that subjects were unaware of memory deterioration . CONCLUSIONS While darifenacin had no significant effects on memory versus placebo , oxybutynin ER caused significant memory deterioration ( magnitude of effect comparable to brain aging of 10 years ) . The results also demonstrate that subjects may not recognise/report memory deterioration

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Anti-cholinergic load, health care utilization, and survival in people with advanced cancer: a pilot study.

INTRODUCTION Anti-cholinergic medications have been associated with increased risks of cognitive impairment , premature mortality and increased risk of hospitalisation . Anti-cholinergic load associated with medication increases as death approaches in those with advanced cancer , yet little is known about associated adverse outcomes in this setting . METHODS A sub study of 112 participants in a r and omised control trial who had cancer and an Australia modified Karnofsky Performance Scale ( AKPS ) score ( AKPS ) of 60 or above , explored survival and health service utilisation ; with anti-cholinergic load calculated using the Clinician Rated Anti-cholinergic Scale ( modified version ) longitudinally to death . A st and ardised starting point for prospect ively calculating survival was an AKPS of 60 or above . RESULTS Baseline entry to the sub- study was a mean 62 + /- 81 days ( median 37 , range 1 - 588 ) days before death ( survival ) , with mean of 4.8 ( median 3 , SD 4.18 , range 1 - 24 ) study assessment s in this time period . Participants spent 22 % of time as an inpatient . There was no significant association between anti-cholinergic score and time spent as an inpatient ( adjusted for survival time ) ( p = 0.94 ) ; or survival time . DISCUSSION No association between anti-cholinergic load and survival or time spent as an inpatient was seen . Future studies need to include cognitively impaired population s where the risks of symptomatic deterioration may be more substantial

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial.

BACKGROUND Observational studies report a relationship between anticholinergic drug scale ( ADS ) score and cognitive function . This study investigated whether a reduced ADS score improved cognitive function in a frail elderly population . METHODS This r and omized , controlled , single-blinded trial , recruited long-term residents with an ADS score of greater than or equal to 3 from 22 nursing homes in Norway . The participants were r and omly allocated ( 1:1 ) to intervention or control . The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug review s. Primary end point was Consortium to Establish a Registry for Alzheimer 's Disease 10-wordlist test for immediate recall . Secondary end points were Mini-Mental Sate Examination , delayed recall and recognition of words , saliva flow , and serum anticholinergic activity (SAA).The participants were retested after 4 and 8 weeks , and the study groups were compared after adjusting for baseline differences . RESULTS Eighty-seven patients were included . The median ADS score was reduced by 2 units ( p < .0001 ) in the intervention group and remained unchanged in the control group . After 8 weeks , the adjusted mean difference in immediate recall was 0.54 words between the intervention and control group ( 95 % confidence interval [ CI ] : -0.91 , 2.05 ; p = .48 ) . The study groups did not differ significantly in any of the other cognitive end points , salvia flow , or SAA at either follow-up ( p > .18 ) . CONCLUSION Pharmacist-initiated drug changes significantly reduced ADS score but did not improve cognitive function in nursing home residents . Moreover , the drug changes did not reduce SAA or mouth dryness significantly , which might indicate limited applicability of the ADS score to prevent prescription risks in this population

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Assessment of cognitive function of the elderly population: effects of darifenacin.

PURPOSE Overactive bladder is common in the elderly population , which is susceptible to cognitive disorders and drug induced cognitive impairment . Existing overactive bladder treatments may cause adverse events , such as cognitive impairment , due to antagonism of the M1 receptor in the central nervous system . In this study we evaluated the effect of darifenacin , an M3 selective antagonist , on cognitive function in elderly volunteers without clinical dementia . MATERIAL S AND METHODS This double-blind , 3-period crossover study r and omized 129 volunteers 65 years or older with no/mild cognitive impairment to receive 3 of 5 treatments , namely darifenacin controlled release ( 3.75 , 7.5 or 15 mg once daily ) , darifenacin immediate-release ( 5 mg 3 times daily ) or matching placebo for 14 days . Each treatment period was separated by 7 days of washout . Cognitive function tests were completed at baseline and at treatment end . RESULTS For the primary end points of memory scanning sensitivity , speed of choice reaction time and word recognition sensitivity , there were no statistically significant differences for darifenacin vs placebo . There were no statistically significant differences in secondary variables except memory scanning speed , which increased in all groups relative to baseline , but improvement was greater with placebo than with 3.75 mg darifenacin . Darifenacin treatment was not associated with changes in alertness , contentment or calmness , which are likely to be clinical ly relevant . Darifenacin was well tolerated . CONCLUSIONS : In elderly volunteers 2 weeks of treatment with darifenacin had no effect on cognitive function compared with baseline and it was not significantly different from placebo . This may be related to its M3 receptor selectivity with negligible M1 receptor antagonism

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study

Abstract Objective To assess the potential of anticholinergic drugs as a cause of non-degenerative mild cognitive impairment in elderly people . Design Longitudinal cohort study . Setting 63 r and omly selected general practice s in the Montpellier region of southern France . Participants 372 people aged > 60 years without dementia at recruitment . Main outcome measures Anticholinergic burden from drug use , cognitive examination , and neurological assessment . Results 9.2 % of subjects continuously used anticholinergic drugs during the year before cognitive assessment . Compared with non-users , they had poorer performance on reaction time , attention , delayed non-verbal memory , narrative recall , visuospatial construction , and language tasks but not on tasks of reasoning , immediate and delayed recall of wordlists , and implicit memory . Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35 % of non-users , and anticholinergic drug use was a strong predictor of mild cognitive impairment ( odds ratio 5.12 , P = 0.001 ) . No difference was found between users and non-users in risk of developing dementia at follow-up after eight years . Conclusions Elderly people taking anticholinergic drugs had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired , although not at increased risk for dementia . Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Cumulative anticholinergic exposure is associated with poor memory and executive function in older men.

OBJECTIVES To examine the longitudinal relationship between cumulative exposure to anticholinergic medications and memory and executive function in older men . DESIGN Prospect i ve cohort study . SETTING A Department of Veterans Affairs primary care clinic . PARTICIPANTS Five hundred forty-four community-dwelling men aged 65 and older with diagnosed hypertension . MEASUREMENTS The outcomes were measured using the Hopkins Verbal Recall Test ( HVRT ) for short-term memory and the instrumental activity of daily living ( IADL ) scale for executive function at baseline and during follow-up . Anticholinergic medication use was ascertained using participants ' primary care visit records and quantified as total anticholinergic burden using a clinician-rated anticholinergic score . RESULTS Cumulative exposure to anticholinergic medications over the preceding 12 months was associated with poorer performance on the HVRT and IADLs . On average , a 1-unit increase in the total anticholinergic burden per 3 months was associated with a 0.32-point ( 95 % confidence interval (CI)= 0.05 - 0.58 ) and 0.10-point ( 95 % CI=0.04 - 0.17 ) decrease in the HVRT and IADLs , respectively , independent of other potential risk factors for cognitive impairment , including age , education , cognitive and physical function , comorbidities , and severity of hypertension . The association was attenuated but remained statistically significant with memory ( 0.29 , 95 % CI=0.01 - 0.56 ) and executive function ( 0.08 , 95 % CI=0.02 - 0.15 ) after further adjustment for concomitant non-anticholinergic medications . CONCLUSION Cumulative anticholinergic exposure across multiple medications over 1 year may negatively affect verbal memory and executive function in older men . Prescription of drugs with anticholinergic effects in older persons deserves continued attention to avoid deleterious adverse effects

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Delirium in acute stroke: a preliminary study of the role of anticholinergic medications

The pathogenesis of delirium in acute stroke is incompletely understood . The use of medications with anticholinergic ( ACH ) activity is associated with an increased frequency of delirium . We hypothesized that the intake of medications with ACH activity is associated with delirium in acute stroke patients . Delirium was assessed using the DSM‐IV‐TR criteria and the Delirium Rating Scale , in a sample of consecutive patients with an acute ( ≤4 days ) cerebral infa rct or intracerebral haemorrhage ( ICH ) . We performed a gender and age matched case – control study . Twenty‐two delirious stroke patients ( cases ) and 52 non‐delirious patients ( controls ) were compared concerning the intake of ACH medications ( i ) before stroke , ( ii ) during hospitalization but before the assessment . The variables associated with delirium on bivariate analysis were entered in a stepwise logistic regression analysis . The final regression model ( Nagelkerke R2 = 0.65 ) retained non‐neuroleptics ACH medication during hospitalization ( OR = 24.4 ; 95 % CI = 2.18–250 ) , medical complications ( OR = 20.8 ; 95 % CI = 3.46–125 ) , ACH medication taken before stroke ( OR = 17.5 ; 95 % CI = 1.00–333.3 ) and ICH ( OR = 16.9 ; 95 % CI = 2.73–100 ) as independent predictors of delirium . This preliminary result indicates that drugs with subtle ACH activity play a role in the pathogeneses of delirium in acute stroke . Medication with ACH activity should be avoided in acute stroke patients

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events.

BACKGROUND The use of drugs with anticholinergic adverse effects is often deemed inappropriate in elderly ( aged > or = 65 years ) patients , yet studies continue to show extensive use in this population at high risk for adverse drug events ( ADEs ) . The burden of drug-related anticholinergic symptoms in community-dwelling elderly patients has not been well described . OBJECTIVE The aim of this study was to assess the prevalence of anticholinergic symptoms , corresponding symptom burden , and anticholinergic-related ADEs in a sample of community-dwelling elderly veterans . METHODS This prospect i ve cohort study was conducted at the primary care clinics at the Veterans Affairs Medical Center ( VAMC ) , Iowa City , Iowa . The study sample included r and omly selected patients with intact cognitive function attending the VAMC and prescribed > or = 5 scheduled medications . Data on current prescription and nonprescription drug use were elicited by a trained research assistant and a clinical pharmacist from patient interviews and electronic medical records . The prevalence and severity of 7 anticholinergic symptoms ( dry mouth , constipation , blurred vision , confusion , urinary hesitation , dry eyes , and drowsiness ) were assessed at baseline . The occurrence of ADEs at 12 weeks was compared between patients using anticholinergic drugs and those not using them . RESULTS A total of 532 patients were included ( 97.9 % men ; mean age , 74.3 years ; 27.1 % used at least 1 anticholinergic drug ) . Twenty-two anticholinergic drugs ( 16 prescription medications , 6 over-the-counter medications ) were identified . The mean number of anticholinergic symptoms was significantly higher in the group using anticholinergic drugs ( 3.1 vs 2.5 ; P < 0.01 ) . However , only 2 symptoms were statistically more prevalent in the group using anticholinergic drugs : dry mouth ( 57.6 % vs 45.6 % ) and constipation ( 42.4 % vs 29.4 % ) ( both , P < 0.01 ) . At 12 weeks , only 1 ( 0.8 % ) patient in the group using anticholinergic drugs reported an ADE considered related to an anticholinergic drug . CONCLUSIONS Anticholinergic drug use was common ( 27.1 % ) in these elderly veterans with intact cognitive function . The mean number of anticholinergic symptoms was significantly greater in this group , and the prevalences of dry mouth and constipation were significantly higher in the group using anticholinergic drugs ( all , P < 0.01 ) . Anticholinergic-related ADEs were rare ( 0.8 % ) . Although anticholinergic drugs should generally be avoided in the elderly , individual risks and benefits for a patient should be considered

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Association of Anticholinergic Burden with Cognitive and Functional Status in a Cohort of Hospitalized Elderly: Comparison of the Anticholinergic Cognitive Burden Scale and Anticholinergic Risk Scale

Background Drugs with anticholinergic effects are associated with adverse events such as delirium and falls as well as cognitive decline and loss of independence . Objective The aim of the study was to evaluate the association between anticholinergic burden and both cognitive and functional status , according to the hypothesis that the cumulative anticholinergic burden , as measured by the Anticholinergic Cognitive Burden ( ACB ) Scale and Anticholinergic Risk Scale ( ARS ) , increases the risk of cognitive decline and impairs activities of daily living . Methods This cross-sectional , prospect i ve study ( 3-month telephone follow-up ) was conducted in 66 Italian internal medicine and geriatric wards participating in the Registry of Polytherapies SIMI ( Società Italiana di Medicina Interna ) ( REPOSI ) study during 2010 . The sample included 1,380 in patients aged 65 years or older . Cognitive status was rated with the Short Blessed Test ( SBT ) and physical function with the Barthel Index . Each patient ’s anticholinergic burden was evaluated using the ACB and ARS scores . Results The mean SBT score for patients treated with anticholinergic drugs was higher than that for patients receiving no anticholinergic medications as also indicated by the ACB scale , even after adjustment for age , sex , education , stroke and transient ischaemic attack [ 9.2 ( 95 % CI 8.6–9.9 ) vs. 8.5 ( 95 % CI 7.8–9.2 ) ; p = 0.05 ] . There was a dose – response relationship between total ACB score and cognitive impairment . Patients identified by the ARS had more severe cognitive and physical impairment than patients identified by the ACB scale , and the dose – response relationship between this score and ability to perform activities of daily living was clear . No correlation was found with length of hospital stay . Conclusions Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients . The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose – response pattern , but the ARS is better at rating activities of daily living

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Association of Anticholinergic Drugs with Hospitalization and Mortality among Older Cardiovascular Patients

Abstract Background : Many potentially inappropriate drugs prescribed to older people have anticholinergic properties as adverse effects and are therefore potentially harmful . These effects typically include constipation , dry mouth , blurred vision , dizziness and slowing of urination . It has been shown that drugs with anticholinergic properties ( DAPs ) are associated with cognitive decline and dementia , may contribute to events such as falls , delirium and impulsive behaviour , are associated with self-reported adverse effects and physical impairment , and may even be associated with mortality . However , studies of the prognostic implication s of DAPs remain scarce . Objective : To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease ( CVD ) . Methods : This was a prospect i ve study with a mean follow-up of 3.3 years involving two study groups : users ( n = 295 ) and non-users ( n = 105 ) of DAPs . The participants were 400 community-dwelling older people ( aged 75–90 years ) with stable CVD participating in a secondary prevention study of CVD ( DEBATE ) in Helsinki , Finl and . The use of DAPs was estimated using definitions from the previous scientific literature . The Charlson Comorbidity Index ( CCI ) was used to estimate the burden of co-morbidity and the Mini-Mental State Examination test was used to assess cognitive function . The risks in the two study groups for hospital visits , number of days spent in hospital care and mortality were measured from 2000 to the end of 2003 . Results : The unadjusted follow-up mortality was 20.7 % and 9.5 % among the users and non-users of DAPs , respectively ( p = 0.010 ) . However , the use of DAPs was not a significant predictor of mortality in multivariate analysis after adjustment for age , sex and CCI score ( hazard ratio 1.57 ; 95 % CI 0.78 , 3.15 ) . The mean ± SD number of hospital days per person-year was higher in the DAP user group ( 14.9± 32.5 ) than in the non-user group ( 5.2± 12.3 ) [ p < 0.001 ] . In a bootstrap-type analysis of covariance adjusted for age , sex and CCI score , the use of DAPs predicted the number of days spent in hospital ( p = 0.011 ) . Conclusions : The use of DAPs in older patients with stable CVD was associated with an increased number of hospital days but not with mortality

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Use of medications with anticholinergic properties and cognitive function in a young-old community sample.

OBJECTIVES To examine whether anticholinergic medications have effects on the level of cognitive function or cognitive decline in persons in their early to mid 60s . METHODS A r and omly selected community-based sample of 2058 persons aged 60 - 64 at baseline was interviewed twice over four years . Anticholinergic medication use was determined from self-report medication data using the Anticholinergic Drug Scale . Cognition was assessed with the California Verbal Learning Test I ( one trial ) , Digits Backwards , the Symbol Digit Modalities Test , the Mini-Mental State Exam and simple and choice reaction time . Persons meeting criteria for Mild Cognitive Impairment were identified in a clinical sub study . Mixed models adjusting for age , sex , self-rated depression and physical health , and total number of medications were used to analyse the data . RESULTS There was a significant main effect of anticholinergic group averaged across time for the Symbol Digits Modalities Test with poorer performance among anticholinergic medication users . Main effects for the other cognitive tests and mild cognitive impairment were non-significant . No time by anticholinergic group interactions were significant . CONCLUSIONS This study suggests that exposure to anticholinergic medication is associated with lower level of complex attention in the young-old , but not with greater cognitive decline over time . Although the clinical significance of this is not clear , caution should be taken when prescribing medications with anticholinergic effects to older persons

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Exploratory pilot study assessing the risk of cognitive impairment or sedation in the elderly following single doses of solifenacin 10 mg

Objectives : To assess the cognitive effects of single doses of solifenacin 10 mg compared with placebo ( primary objective ) and oxybutynin immediate release ( IR ) 10 mg ( secondary objective ) in elderly subjects . Methods : Single-centre , r and omised , double-blind , placebo-controlled study in 12 healthy elderly volunteers , with three crossover periods separated by two 14-day washout periods . Each sequence consisted of a single dose of solifenacin 10 mg in one period , oxybutynin IR 10 mg in another and placebo in another . Aspects of attention , information processing , working memory , episodic memory and self-rated mood and alertness were tested using the vali date d Cognitive Drug Research computerised assessment system . Results : There was no evidence from absolute mean values or changes from baseline to suggest that solifenacin 10 mg impaired cognition or self-ratings of mood and alertness versus placebo . Post-hoc ANCOVA showed no statistically significant cognitive deterioration with solifenacin versus placebo , when measured at a time point closest to the probable Cmax of solifenacin . Oxybutynin was associated with statistically significant impairments in several measures of cognitive function at a time point corresponding with its probable Cmax . Conclusion : In this pilot study , single 10 mg doses of solifenacin did not show any clear propensity to impair cognitive function in a healthy elderly population

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Associations between drug burden index and falls in older people in residential aged care.

OBJECTIVES To evaluate the association between the Drug Burden Index ( DBI ) , a measure of a person 's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people , and falls in residents of residential aged care facilities ( RACFs ) . DESIGN Data were drawn from participants in a r and omized controlled trial that investigated falls and fractures . SETTING RACFs in Sydney , Australia . PARTICIPANTS Study participants ( N=602 ; 70.9 % female ) were recruited from 51 RACFs . Mean age was 85.7 ± 6.4 , and mean DBI was 0.60 ± 0.66 . MEASUREMENTS Medication history was obtained on each participant . Drugs were classified as anticholinergic or sedative and a DBI was calculated . Falls were measured over a 12-month period . Comorbidity , cognitive impairment ( Mini-Mental State Examination ) and depression ( Geriatric Depression Scale ) were determined . RESULTS There were 998 falls in 330 individuals during a follow-up period of 574.2 person-years , equating to an average rate of 1.74 falls per person-year . The univariate negative binomial regression model for falls showed incidence rate ratios of 1.69 ( 95 % confidence interval (CI)=1.22 - 2.34 ) for low DBI ( < 1 ) and 2.11 ( 95 % CI=1.47 - 3.04 ) for high DBI ( ≥1 ) when compared with those who had a DBI of 0 . After adjusting for age , sex , history of falling , cognitive impairment , depression , use of a walking aid , comorbidities , polypharmacy , and incontinence , incident rate ratios of 1.61 ( 95 % CI=1.17 - 2.23 ) for low DBI and 1.90 ( 95 % CI=1.30 - 2.78 ) for high DBI were obtained . CONCLUSION DBI is significantly and independently associated with falls in older people living in RACFs . Interventional studies design ed for this population are needed to determine whether reducing DBI , through dose reduction or cessation of anticholinergic and sedative drugs , can prevent falls

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Changes in cognitive functioning with risperidone and olanzapine treatment: a large-scale, double-blind, randomized study

Objective The effects of risperidone and olanzapine on cognitive functioning in patients with schizophrenia were compared in a r and omized , double-blind trial . Method Three hundred and seventy-seven patients were r and omly assigned to receive 2–6 mg/day of risperidone or 5–20 mg/day of olanzapine for 8 weeks . Cognitive function was assessed with a focused cognitive assessment battery ; in addition , extrapyramidal symptoms were assessed using the extrapyramidal symptom rating scale ( ESRS ) , and the positive and negative syndrome scale ( PANSS ) was rated for all patients . Results Treatment with these two atypical antipsychotic medications was associated with improved performance on the Wisconsin card sorting test , the trail-making test , the California verbal learning test , the continuous performance test , and some aspects of verbal fluency and spatial working memory . No differences in the effects of the drugs on any of the cognitive tests were noted . Correcting for the effects of anticholinergic treatment did not alter the magnitude of cognitive effects . Conclusions Atypical antipsychotic treatment is associated with wide-ranging benefits on cognitive functioning . Previous reports of greater benefits of olanzapine over risperidone in a small- sample pilot study were not substantiated . These results are not due in general to changes in clinical symptoms or movement disorders , suggesting a direct effect of atypical antipsychotic medications on cognitive deficits in schizophrenia

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

Association between prescribing of anticholinergic medications and incident delirium: a cohort study.

OBJECTIVES To describe the association between anticholinergic medications and incident delirium in hospitalized older adults with cognitive impairment and to test the hypothesis that anticholinergic medications would increase the risk of incident delirium . DESIGN Observational cohort study . SETTING Urban public hospital in Indianapolis , Indiana . PARTICIPANTS One hundred forty-seven participants aged 65 and older with cognitive impairment who screened negative for delirium at the time of admission to a general medical ward . MEASUREMENTS Cognitive function at the time of admission was assessed using the Short Portable Mental Status Question naire ( SPMSQ ) . Anticholinergic medication orders between the time of admission and the final delirium assessment were evaluated . Anticholinergic medication orders were identified using the Anticholinergic Cognitive Burden Scale . Delirium was assessed using the Confusion Assessment Method . RESULTS Fifty-seven percent of the cohort received at least one order for possible anticholinergic medications , and 28 % received at least one order for definite anticholinergic medications . The incident rate for delirium was 22 % of the entire cohort . After adjusting for age , sex , race , baseline SPMSQ score , and Charlson Comorbidity Index , the odds ratio ( OR ) for developing delirium in those with orders for possible anticholinergic medications was 0.33 ( 95 % confidence interval ( CI ) = 0.10 - 1.03 ) . The OR for developing delirium among those with orders for definite anticholinergic medications was 0.43 ( 95 % CI = 0.11 - 1.63 ) . CONCLUSION The results did not support the hypothesis that prescription of anticholinergic medications increases the risk of incident delirium in hospitalized older adults with cognitive impairment . This relationship needs to be established using prospect i ve study design s with medication dispensing data to improve the performance of predictive models of delirium

medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes

OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Vitamin K2 inhibits glucocorticoid-induced bone loss partly by preventing the reduction of osteoprotegerin (OPG)

We have recently demonstrated that glucocorticoid ( GC ) suppresses bone formation and enhances bone resorption , with result ant bone loss . This altered bone turnover is not due to the action of parathyroid hormone ( PTH ) , but appears to be related to the suppression of osteoprotegerin ( OPG ) . As vitamin K2 ( menatetrenone ) has been used for the treatment of osteoporosis , the present study was carried out to evaluate the effect of vitamin K2 on GC-induced bone loss . Twenty patients with chronic glomerulonephritis treated with GC for the first time were chosen for this study . Ten patients received GC alone ( group A ) and the other 10 patients each received 15 mg of vitamin K2 per day in addition to GC ( group B ) . Markers of bone metabolism , including serum OPG , osteocalcin ( OC ) , bone-specific alkaline phosphatase activity ( BAP ) , PTH , tartrate-resistant acid phosphatase ( TRAP ) , and bone mineral density ( BMD ) , were measured before and during the treatment . OPG was significantly decreased in group A ( P < 0.001 ) , while no significant change was seen in group B. TRAP was markedly increased in both groups , more particularly in group A ( P < 0.01 ) . PTH was decreased in group A , but was increased in group B. OC was decreased at month 1 but subsequently increased until month 12 in both groups . BAP had decreased at month 3 in group A ( P < 0.05 ) , but not in group B. BMD of the lumbar spine was significantly reduced after 6 months ( P < 0.01 ) , and 12 months ( P < 0.001 ) of treatment in group A , whereas there was no remarkable change in group B. The present study demonstrated that the inhibition exerted by vitamin K2 of the reduction in OPG induced by GC may , at least in part , play a role in the prevention and treatment of GC-induced bone loss

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis.

BACKGROUND Osteoporotic structural damage and bone fragility result from reduced bone formation and increased bone resorption . In a phase 2 clinical trial , strontium ranelate , an orally active drug that dissociates bone remodeling by increasing bone formation and decreasing bone resorption , has been shown to reduce the risk of vertebral fractures and to increase bone mineral density . METHODS To evaluate the efficacy of strontium ranelate in preventing vertebral fractures in a phase 3 trial , we r and omly assigned 1649 postmenopausal women with osteoporosis ( low bone mineral density ) and at least one vertebral fracture to receive 2 g of oral strontium ranelate per day or placebo for three years . We gave calcium and vitamin D supplements to both groups before and during the study . Vertebral radiographs were obtained annually , and measurements of bone mineral density were performed every six months . RESULTS New vertebral fractures occurred in fewer patients in the strontium ranelate group than in the placebo group , with a risk reduction of 49 percent in the first year of treatment and 41 percent during the three-year study period ( relative risk , 0.59 ; 95 percent confidence interval , 0.48 to 0.73 ) . Strontium ranelate increased bone mineral density at month 36 by 14.4 percent at the lumbar spine and 8.3 percent at the femoral neck ( P<0.001 for both comparisons ) . There were no significant differences between the groups in the incidence of serious adverse events . CONCLUSIONS Treatment of postmenopausal osteoporosis with strontium ranelate leads to early and sustained reductions in the risk of vertebral fractures

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture in elderly women.

It has been previously shown that the level of circulating undercarboxylated osteocalcin ( ucOC ) is elevated in elderly women in comparison with young , healthy , premenopausal ones . To underst and the mechanism of the increase in the ucOC in the elderly and to assess its potential consequences on bone fragility , we have measured ucOC in the sera of 195 elderly institutionalized women 70 - 101 yr of age . In 45 women ( 23 % ) serum ucOC was above the upper limit of the normal range for young women . The level of ucOC was negatively correlated with 25OHD ( r = -0.32 , P < 0.001 ) even after excluding the effect of age , parathyroid hormone ( PTH ) , and creatinine by partial correlation ( r = -0.24 , P < 0.002 ) . During an 18-mo follow-up , 15 women sustained a hip fracture and their baseline ucOC level was higher ( P < 0.01 ) in women who subsequently sustained hip fracture than in the nonfracture group contrasting with no significant differences for serum calcium , phosphate , alkaline phosphatase , creatinine , PTH , 250HD , and total and carboxylated OC . The risk of hip fracture was increased in women with elevated ucOC ( relative ratio 5.9 , 99.9 % Cl 1.5 - 22.7 , P < 0.001 ) . During 1 yr of calcium/vitamin D2 treatment , ucOC decreased ( P < 0.05 ) , especially in those with the initially increased values ( from 2.22 + /- 0.35 to 1.41 + /- 0.29 ng/ml , P < 0.005 ) contrasting with an increase in the placebo group ( P < 0.05 ) . In conclusion , the increase in ucOC in the elderly reflects not only some degree of vitamin K deficiency but also their poor vitamin D status , suggesting that vitamin D may be important , either directly or indirectly through its effect on bone turnover , for achieving a normal gamma-carboxylation of OC . The ucOC , but not conventional calcium metabolism parameters , predicts the subsequent risk of hip fracture , suggesting that serum ucOC reflects some changes in bone matrix associated with increased fragility

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Vitamin K intake and hip fractures in women: a prospective study.

BACKGROUND Vitamin K mediates the gamma-carboxylation of glutamyl residues on several bone proteins , notably osteocalcin . High serum concentrations of undercarboxylated osteocalcin and low serum concentrations of vitamin K are associated with lower bone mineral density and increased risk of hip fracture . However , data are limited on the effects of dietary vitamin K. OBJECTIVE We investigated the hypothesis that high intakes of vitamin K are associated with a lower risk of hip fracture in women . DESIGN We conducted a prospect i ve analysis within the Nurses ' Health Study cohort . Diet was assessed in 72327 women aged 38 - 63 y with a food-frequency question naire in 1984 ( baseline ) . During the subsequent 10 y of follow-up , 270 hip fractures result ing from low or moderate trauma were reported . RESULTS Women in quintiles 2 - 5 of vitamin K intake had a significantly lower age-adjusted relative risk ( RR : 0.70 ; 95 % CI : 0.53 , 0.93 ) of hip fracture than women in the lowest quintile ( < 109 microg/d ) . Risk did not decrease between quintiles 2 and 5 and risk estimates were not altered when other risk factors for osteoporosis , including calcium and vitamin D intakes , were added to the models . Risk of hip fracture was also inversely associated with lettuce consumption ( RR : 0.55 ; 95 % CI : 0.40 , 0.78 ) for one or more servings per day compared with one or fewer servings per week ) , the food that contributed the most to dietary vitamin K intakes . CONCLUSIONS Low intakes of vitamin K may increase the risk of hip fracture in women . The data support the suggestion for a re assessment of the vitamin K requirements that are based on bone health and blood coagulation

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Vitamin K, bone turnover, and bone mass in girls.

BACKGROUND Vitamin K has been suggested to have a role in bone metabolism , and low vitamin K intake has been related to low bone density and increased risk of osteoporotic fracture . OBJECTIVE The objective of this study was to determine whether phylloquinone ( vitamin K(1 ) ) intake and biochemical indicators of vitamin K status are related to bone mineral content ( BMC ) and markers of bone formation and bone resorption in girls . DESIGN Vitamin K status [ plasma phylloquinone concentration and percentage of undercarboxylated osteocalcin ( % ucOC ) ] was measured at baseline in a study of 245 healthy girls aged 3 - 16 y. Cross-linked N-telopeptide of type 1 collagen ( NTx ) breakdown , osteocalcin , and bone-specific alkaline phosphatase were measured to reflect bone resorption and formation . BMC of the total body , lumbar spine , and hip and dietary phylloquinone intake were measured annually for 4 y. RESULTS Phylloquinone intake ( median : 45 microg/d ) was not consistently associated with bone turnover markers or BMC . Better vitamin K status ( high plasma phylloquinone and low % ucOC ) was associated with lower bone resorption and formation . Plasma phylloquinone was inversely associated with NTx and osteocalcin concentrations ( P < 0.05 ) , and % ucOC was positively associated with NTx and bone-specific alkaline phosphatase concentrations ( P < 0.05 ) . Indicators of vitamin K status were not consistently associated with current BMC or gain in BMC over the 4-y study period . CONCLUSIONS Better vitamin K status was associated with decreased bone turnover in healthy girls consuming a typical US diet . R and omized phylloquinone supplementation trials are needed to further underst and the potential benefits of phylloquinone on bone acquisition in growing children

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Factors Affecting Bone Loss in Female Endurance Athletes

Background : Low bone mass leading to stress fractures is a well-known and yet unsolved problem among female athletes . Purpose : To quantify the rate of bone loss in healthy female athletes and investigate the effects of estrogen and vitamin K supplementation on bone loss . Study Design : Prospect i ve cohort study . Methods : We classified 115 female endurance athletes into amenorrheic , eumenorrheic , or estrogen-supplemented groups and r and omized them to receive either placebo or vitamin K1 . The bone mineral densities of the subjects ' femoral neck and lumbar spine were measured at baseline and after 2 years . Results : Bone mineral density in the lumbar spine remained constant , but bone density in the femoral neck had decreased significantly after 2 years in all three subgroups . The decrease was higher in amenorrheic ( —6.5 % ± 4.0 % ) than in eumenorrheic ( —3.2 % ± 4.1 % ) and estrogen-supplemented athletes ( —3.9 % ± 3.1 % ) . Supplementation with vitamin K did not affect the rate of bone loss . Conclusions : The rate of bone loss in all three subgroups of female athletes was unexpectedly high ; neither estrogen nor vitamin K supplementation prevented bone loss . Clinical Relevance : High-intensity training maintained over several years must be regarded in women as a risk factor for osteoporosis , and protocol s for optimal treatment should be developed

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Menaquinone-4 in breast milk is derived from dietary phylloquinone.

The effect of maternal phylloquinone supplementation on vitamin K in breast milk was studied to establish : ( 1 ) if phylloquinone is the source of menaquinone-4 in breast milk ; ( 2 ) the dose-effect relationship between intake and obtainable levels . Four groups of lactating mothers with a full-term healthy infant participated and took oral phylloquinone supplements of 0.0 ( n 8) , 0.8 ( n 8) , 2.0 ( n 8) , and 4.0 ( n 7 ) mg/d for 12d , starting at day 4 post-partum . Milk sample s were collected on days 4 , 8 , 16 , and 19 . Blood sample s were collected on days 4 and 16 . Vitamin K and vitamin E concentrations , the latter for reason of comparison , were assayed . Phylloquinone and menaquinone-4 were present in all milk sample s : 5.84 ( SD 2.31 ) and 2.98 ( SD 1.51 ) nmol/l ( n 31 ) respectively , in colostrum ( day 4 sample ) . A strong correlation between the vitamers was found ( r 0.78 , P<0.001 ) . Breast-milk phylloquinone levels were raised in a dose-dependent manner : 4- , 12- , and 30-fold on day 16 for the 08 , 2.0 , and 4.0 mg group respectively . In addition , menaquinone-4 levels were higher : 2.5- ( P<0.05 ) and 7-fold ( P<0.001 ) in the 2.0 and 4.0 mg groups respectively . Plasma of supplemented subjects contained 3- , 5- , and 10-fold higher phylloquinone levels on day 16 . Detectable menaquinone-4 was found in ten of thirty-one day 4 plasma sample s. All day 16 plasma sample s of the 4 mg supplemented group contained the vitamin . There was no correlation between the K-vitamers in plasma . Vitamin E and phylloquinone appear to differ in their distribution in breast milk , milk : plasma concentration ratios were < or = 1 and 3 - 5 for vitamin E and phylloquinone respectively . The milk : plasma concentration ratio of menaquinone-4 was > 10 . In conclusion , dietary phylloquinone is a source of menaquinone-4 in breast milk . Phylloquinone supplementation to lactating mothers may be of benefit to the newborn infant , since both phylloquinone and menaquinone-4 are raised by supplementation

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures

BACKGROUND Previous studies have shown that alendronate can increase bone mineral density ( BMD ) and prevent radiographically defined ( morphometric ) vertebral fractures . The Fracture Intervention Trial aim ed to investigate the effect of alendronate on the risk of morphometric as well as clinical ly evident fractures in postmenopausal women with low bone mass . METHODS Women aged 55 - 81 with low femoral-neck BMD were enrolled in two study groups based on presence or absence of an existing vertebral fracture . Results for women with at least one vertebral fracture at baseline are reported here . 2027 women were r and omly assigned placebo ( 1005 ) or alendronate ( 1022 ) and followed up for 36 months . The dose of alendronate ( initially 5 mg daily ) was increased ( to 10 mg daily ) at 24 months , with maintenance of the double blind . Lateral spine radiography was done at baseline and at 24 and 36 months . New vertebral fractures , the primary endpoint , were defined by morphometry as a decrease of 20 % ( and at least 4 mm ) in at least one vertebral height between the baseline and latest follow-up radiograph . Non-spine clinical fractures were confirmed by radiographic reports . New symptomatic vertebral fractures were based on self-report and confirmed by radiography . FINDINGS Follow-up radiographs were obtained for 1946 women ( 98 % of surviving participants ) . 78 ( 8.0 % ) of women in the alendronate group had one or more new morphometric vertebral fractures compared with 145 ( 15.0 % ) in the placebo group ( relative risk 0.53 [ 95 % Cl 0.41 - 0.68 ] ) . For clinical ly apparent vertebral fractures , the corresponding numbers were 23 ( 2.3 % ) alendronate and 50 ( 5.0 % ) placebo ( relative hazard 0.45 [ 0.27 - 0.72 ] ) . The risk of any clinical fracture , the main secondary endpoint , was lower in the alendronate than in the placebo group ( 139 [ 13.6 % ] vs 183 [ 18.2 % ] ; relative hazard 0.72 [ 0.58 - 0.90 ] ) . The relative hazards for hip fracture and wrist fracture for alendronate versus placebo were 0.49 ( 0.23 - 0.99 ) and 0.52 ( 0.31 - 0.87 ) . There was no significant difference between the groups in numbers of adverse experiences , including upper-gastrointestinal disorders . INTERPRETATION We conclude that among women with low bone mass and existing vertebral fractures , alendronate is well tolerated and substantially reduces the frequency of morphometric and clinical vertebral fractures , as well as other clinical fractures

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Comparative efficacy of hormone replacement therapy, etidronate, calcitonin, alfacalcidol, and vitamin K in postmenopausal women with osteoporosis: The Yamaguchi Osteoporosis Prevention Study.

PURPOSE To assess the comparative effectiveness of several medications on bone mineral density , biochemical bone markers , and the incidence of vertebral fractures in postmenopausal women with osteoporosis . METHODS A total of 396 postmenopausal women , aged 50 to 75 years , were allocated r and omly to six equal-sized groups : hormone replacement therapy , etidronate , eel calcitonin , alfacalcidol , vitamin K ( menatetrenone ) , or control ( no treatment ) . Thoracic and lumbar spine radiographs , bone mineral density at the distal radius , and markers of bone turnover were assessed at baseline and every 3 months during the 2-year study . RESULTS Compared with baseline , the 2-year mean changes in bone mineral density were 2.0 % for hormone replacement therapy , -0.5 % for etidronate , 1.6 % for calcitonin , -3.6 % for alfacalcidol , -1.9 % for vitamin K , and -3.3 % for control . Seventeen ( 26 % ) of the 66 control patients developed new vertebral fractures . Compared with controls , the relative risks of vertebral fracture were 0.35 ( 95 % confidence interval [ CI ] : 0.14 to 0.83 ) for hormone replacement therapy , 0.40 ( 95 % CI : 0.17 to 0.92 ) for etidronate , 0.41 ( 95 % CI : 0.17 to 0.93 ) for calcitonin , 0.56 ( 95 % CI : 0.26 to 1.12 ) for alfacalcidol , and 0.44 ( 95 % CI : 0.20 to 0.99 ) for vitamin K. CONCLUSION We observed significant reductions in the incidence of vertebral fractures with hormone replacement therapy , etidronate , and calcitonin , and significant improvements in bone mineral density with hormone replacement therapy and calcitonin

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Vitamin K1 Supplementation Retards Bone Loss in Postmenopausal Women Between 50 and 60 Years of Age

Although several observational studies have demonstrated an association between vitamin K status and bone mineral density ( BMD ) in postmenopausal women , no placebo-controlled intervention trials of the effect of vitamin K1 supplementation on bone loss have been reported thus far . In the trial presented here we have investigated the potential complementary effect of vitamin K1 ( 1 mg/day ) and a mineral + vitamin D supplement ( 8 µg/day ) on postmenopausal bone loss . The design of our study was a r and omized , double-blind , placebo-controlled intervention study ; 181 healthy postmenopausal women between 50 and 60 years old were recruited , 155 of whom completed the study . During the 3-year treatment period , participants received a daily supplement containing either placebo , or calcium , magnesium , zinc , and vitamin D ( MD group ) , or the same formulation with additional vitamin K1 ( MDK group ) . The main outcome was the change in BMD of the femoral neck and lumbar spine after 3 years , as measured by DXA . The group receiving the supplement containing additional vitamin K1 showed reduced bone loss of the femoral neck : after 3 years the difference between the MDK and the placebo group was 1.7 % ( 95 % Cl : 0.35–3.44 ) and that between the MDK and MD group was 1.3 % ( 95 % Cl : 0.10–3.41 ) . No significant differences were observed among the three groups with respect to change of BMD at the site of the lumbar spine . If co-administered with minerals and vitamin D , vitamin K1 may substantially contribute to reducing postmenopausal bone loss at the site of the femoral neck

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Amelioration of osteoporosis by menatetrenone in elderly female Parkinson's disease patients with vitamin D deficiency.

Significant reduction in bone mineral density ( BMD ) occurs in patients with Parkinson 's disease ( PD ) , correlating with immobilization and with vitamin D deficiency , and increasing the risk of hip fracture , especially in elderly women . As a biological indicator of compromised vitamin K status , an increased serum concentration of undercarboxylated osteocalcin ( Oc ) has been associated with reduced BMD in the hip and an increased risk of fracture in otherwise healthy elderly women . We evaluated treatment with vitamin K(2 ) ( menatetrenone ; MK-4 ) in maintaining BMD and reducing the incidence of nonvertebral fractures in elderly female patients with PD . In a r and om and prospect i ve study of PD patients , 60 received 45 mg of MK-4 daily for 12 months , and the remaining 60 ( untreated group ) did not . At baseline , patients of both groups showed vitamin D and K(1 ) deficiencies , high serum levels of ionized calcium , and glutaminic residue ( Glu ) Oc , and low levels of parathyroid hormone ( PTH ) and 1,25-dihydroxyvitamin D [ 1,25-(OH)(2)D ] , indicating that immobilization-induced hypercalcemia inhibits renal synthesis of 1,25-(OH)(2)D and compensatory PTH secretion . BMD in the second metacarpals increased by 0.9 % in the treated group and decreased by 4.3 % in the untreated group ( p < 0.0001 ) . Vitamin K(2 ) level increased by 259.8 % in the treated group . Correspondingly , significant decreases in Glu Oc and calcium were observed in the treated group , in association with an increase in both PTH and 1,25-(OH)(2)D. Ten patients sustained fractures ( eight at the hip and two at other sites ) in the untreated group , and one hip fracture occurred among treated patients ( p = 0.0082 ; odds ratio = 11.5 ) . The treatment with MK-4 can increase the BMD of vitamin D- and K-deficient bone by increasing vitamin K concentration , and it can also decrease calcium levels through inhibition of bone resorption , result ing in an increase in 1,25-(OH)(2)D concentration

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Effect of combined administration of vitamin D3 and vitamin K2 on bone mineral density of the lumbar spine in postmenopausal women with osteoporosis

Abstract The effect of the combined administration of vitamin D3 and vitamin K2 on bone mineral density ( BMD ) of the lumbar spine was examined in postmenopausal women with osteoporosis . Ninety-two osteoporotic women who were more than 5 years after menopause , aged 55–81 years , were r and omly divided into four administration groups : vitamin D3 ( 1α hydroxyvitamin D3 , 0.75 μg/day ) ( D group ; n = 29 ) , vitamin K2 ( menatetrenone , 45 mg/day ) ( K group ; n = 22 ) , vitamin D3 plus vitamin K2 ( DK group , n = 21 ) , and calcium ( calcium lactate , 2 g/day ) ( C group ; n = 20 ) . BMD of the lumbar spine ( L2–L4 ) was measured by dual energy X-ray absorptiometry at 0 , 1 , and 2 years after the treatment started . There were no significant differences in age , body mass index , years since menopause , and initial BMD among the four groups . One-way analysis of variance ( ANOVA ) with repeated measurements showed a significant decrease in BMD in the C group ( P < 0.001 ) . Two-way ANOVA with repeated measurements showed a significant increase in BMD in the D and K groups compared with that in the C group ( P < 0.05 and P < 0.001 , respectively ) , and a significant increase in BMD in the DK group compared with that in the C , D , and K groups ( P < 0.0001 , P < 0.05 and P < 0.01 , respectively ) . These findings indicate that combined administration of vitamin D3 and vitamin K2 , compared with calcium administration , appears to be useful in increasing the BMD of the lumbar spine in postmenopausal women with osteoporosis

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Calcium plus vitamin D supplementation and the risk of fractures.

BACKGROUND The efficacy of calcium with vitamin D supplementation for preventing hip and other fractures in healthy postmenopausal women remains equivocal . METHODS We recruited 36,282 postmenopausal women , 50 to 79 years of age , who were already enrolled in a Women 's Health Initiative ( WHI ) clinical trial . We r and omly assigned participants to receive 1000 mg of elemental [ corrected ] calcium as calcium carbonate with 400 IU of vitamin D3 daily or placebo . Fractures were ascertained for an average follow-up period of 7.0 years . Bone density was measured at three WHI centers . RESULTS Hip bone density was 1.06 percent higher in the calcium plus vitamin D group than in the placebo group ( P<0.01 ) . Intention-to-treat analysis indicated that participants receiving calcium plus vitamin D supplementation had a hazard ratio of 0.88 for hip fracture ( 95 percent confidence interval , 0.72 to 1.08 ) , 0.90 for clinical spine fracture ( 0.74 to 1.10 ) , and 0.96 for total fractures ( 0.91 to 1.02 ) . The risk of renal calculi increased with calcium plus vitamin D ( hazard ratio , 1.17 ; 95 percent confidence interval , 1.02 to 1.34 ) . Censoring data from women when they ceased to adhere to the study medication reduced the hazard ratio for hip fracture to 0.71 ( 95 percent confidence interval , 0.52 to 0.97 ) . Effects did not vary significantly according to prer and omization serum vitamin D levels . CONCLUSIONS Among healthy postmenopausal women , calcium with vitamin D supplementation result ed in a small but significant improvement in hip bone density , did not significantly reduce hip fracture , and increased the risk of kidney stones . ( Clinical Trials.gov number , NCT00000611 . )

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Use of vitamin K2 (menatetrenone) and 1,25-dihydroxyvitamin D3 in the prevention of bone loss induced by leuprolide.

The purpose of this study is to evaluate the efficacy of vitamin K2 and 1,25-dihydroxyvitamin D3 [ 1,25-(OH)2D3 ] in preventing bone loss induced by estrogen deficiency during therapy with the GnRH agonist ( GnRH-a ) leuprolide . One hundred ten women ( mean age , 46.2+/-0.5 yr ) , receiving leuprolide therapy for estrogen-dependent diseases ( such as endometriosis and uterine leiomyomas ) , were r and omly allocated into four groups ( group A , leuprolide only ; group B , leuprolide with vitamin K2 ; group C , leuprolide with 1,25-(OH)2D3 ; and group D , leuprolide with vitamin K2 and 1,25-(OH)2D3 ) . Bone mineral density of the lumbar spine was measured by dual-energy x-ray absorptiometry before and after 6 months of treatment . Bone formation and resorption markers were also measured before and after 6 months of treatment . There were no significant differences in the background parameters among the four groups . Bone mineral density was reduced in all four groups , but the percent changes varied slightly , at - 5.25 % ( group A ) , -3.72 % ( P < 0.05 vs. group A ) ( group B ) , -4.13 % ( group C ) , and -3.59 % ( P < 0.01 vs. group A ) ( group D ) , respectively . Bone formation markers were significantly increased in all four groups , and the percent changes of bone formation markers were highest in group B. Bone resorption markers also increased significantly in all four groups after treatment of 6 months . Group B tended to have the highest percent changes of bone resorption markers among the four groups , but these increases were not significantly different between any of the groups . Vitamin K2 , especially when combined with 1,25-(OH)2D3 , can partially prevent bone loss caused by estrogen deficiency . However , because this effect is attributable mainly to the activation of bone formation , it is not sufficient to eliminate bone loss induced by GnRH-a therapy

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

A longitudinal study of the effect of vitamin K2 on bone mineral density in postmenopausal women a comparative study with vitamin D3 and estrogen-progestin therapy.

OBJECTIVES To investigate the effect of vitamin K2 treatment for a year on spinal bone mineral density ( BMD ) in postmenopausal women , comparing with vitamin D3 hormone replacement therapy and to determine the factors which affect the efficacy of vitamin K2 therapy . SUBJECTS AND METHODS Seventy-two postmenopausal women were r and omized into four groups and treated with respective agents . Before the therapy , 6 and 12 months after the treatment , their lumbar spine BMD were measured by dual energy X-ray absorptiometry . The rates of change in BMD ( delta BMD ) were calculated . Correlations of BMD with age , year since menopause and the initial BMD were determined . RESULTS Vitamin K2 suppressed the decrease in spinal BMD as compared with no treatment group . BMD in women treated with vitamin K2 was inversely correlated with their age ( r = -0.54 ; P < 0.05 ) . CONCLUSIONS Vitamin K2 therapy may be a useful method for preventing postmenopausal spinal bone mineral loss . In addition , the therapy should be started early in postmenopausal period

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis.

BACKGROUND Once-daily injections of parathyroid hormone or its amino-terminal fragments increase bone formation and bone mass without causing hypercalcemia , but their effects on fractures are unknown . METHODS We r and omly assigned 1637 postmenopausal women with prior vertebral fractures to receive 20 or 40 microg of parathyroid hormone ( 1 - 34 ) or placebo , administered subcutaneously by the women daily . We obtained vertebral radiographs at base line and at the end of the study ( median duration of observation , 21 months ) and performed serial measurements of bone mass by dual-energy x-ray absorptiometry . RESULTS New vertebral fractures occurred in 14 percent of the women in the placebo group and in 5 percent and 4 percent , respectively , of the women in the 20-microg and 40-microg parathyroid hormone groups ; the respective relative risks of fracture in the 20-microg and 40-microg groups , as compared with the placebo group , were 0.35 and 0.31 ( 95 percent confidence intervals , 0.22 to 0.55 and 0.19 to 0.50 ) . New nonvertebral fragility fractures occurred in 6 percent of the women in the placebo group and in 3 percent of those in each parathyroid hormone group ( relative risk , 0.47 and 0.46 , respectively [ 95 percent confidence intervals , 0.25 to 0.88 and 0.25 to 0.861 ) . As compared with placebo , the 20-microg and 40-microg doses of parathyroid hormone increased bone mineral density by 9 and 13 more percentage points in the lumbar spine and by 3 and 6 more percentage points in the femoral neck ; the 40-microg dose decreased bone mineral density at the shaft of the radius by 2 more percentage points . Both doses increased total-body bone mineral by 2 to 4 more percentage points than did placebo . Parathyroid hormone had only minor side effects ( occasional nausea and headache ) . CONCLUSIONS Treatment of postmenopausal osteoporosis with parathyroid hormone ( 1 - 34 ) decreases the risk of vertebral and nonvertebral fractures ; increases vertebral , femoral , and total-body bone mineral density ; and is well tolerated . The 40-microg dose increased bone mineral density more than the 20-microg dose but had similar effects on the risk of fracture and was more likely to have side effects

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis.

We attempted to investigate whether vitamin K2 ( menatetrenone ) treatment effectively prevents the incidence of new fractures in osteoporosis . A total of 241 osteoporotic patients were enrolled in a 24-month r and omized open label study . The control group ( without treatment ; n = 121 ) and the vitamin K2-treated group ( n = 120 ) , which received 45 mg/day orally vitamin K2 , were followed for lumbar bone mineral density ( LBMD ; measured by dual-energy X-ray absorptiometry [ DXA ] ) and occurrence of new clinical fractures . Serum level of Glu-osteocalcin ( Glu-OC ) and menaquinone-4 levels were measured at the end of the follow-up period . Serum level of OC and urinary excretion of deoxypyridinoline ( DPD ) were measured before and after the treatment . The background data of these two groups were identical . The incidence of clinical fractures during the 2 years of treatment in the control was higher than the vitamin K2-treated group ( chi2 = 10.935 ; p = 0.0273 ) . The percentages of change from the initial value of LBMD at 6 , 12 , and 24 months after the initiation of the study were -1.8 + /- 0.6 % , -2.4 + /- 0.7 % , and -3.3 + /- 0.8 % for the control group , and 1.4 + /- 0.7 % , -0.1 + /- 0.6 % , and -0.5 + /- 1.0 % for the vitamin K2-treated group , respectively . The changes in LBMD at each time point were significantly different between the control and the treated group ( p = 0.0010 for 6 months , p = 0.0153 for 12 months , and p = 0.0339 for 24 months ) . The serum levels of Glu-OC at the end of the observation period in the control and the treated group were 3.0 + /- 0.3 ng/ml and 1.6 + /- 0.1 ng/ml , respectively ( p < 0.0001 ) , while the serum level of OC measured by the conventional radioimmunoassay ( RIA ) showed a significant rise ( 42.4 + /-6.9 % from the basal value ) in the treated group at 24 months ( 18.2 + /- 6.1 % for the controls;p = 0.0081 ) . There was no significant change in urinary DPD excretion in the treated group . These findings suggest that vitamin K2 treatment effectively prevents the occurrence of new fractures , although the vitamin K2-treated group failed to increase in LBMD . Furthermore , vitamin K2 treatment enhances gamma-carboxylation of the OC molecule

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial.

BACKGROUND Elderly people who have a fracture are at high risk of another . Vitamin D and calcium supplements are often recommended for fracture prevention . We aim ed to assess whether vitamin D3 and calcium , either alone or in combination , were effective in prevention of secondary fractures . METHODS In a factorial- design trial , 5292 people aged 70 years or older ( 4481 [ 85 % ] of whom were women ) who were mobile before developing a low-trauma fracture were r and omly assigned 800 IU daily oral vitamin D3 , 1000 mg calcium , oral vitamin D3 ( 800 IU per day ) combined with calcium ( 1000 mg per day ) , or placebo . Participants who were recruited in 21 UK hospitals were followed up for between 24 months and 62 months . Analysis was by intention-to-treat and the primary outcome was new low-energy fractures . FINDINGS 698 ( 13 % ) of 5292 participants had a new low-trauma fracture , 183 ( 26 % ) of which were of the hip . The incidence of new , low-trauma fractures did not differ significantly between participants allocated calcium and those who were not ( 331 [ 12.6 % ] of 2617 vs 367 [ 13.7 % ] of 2675 ; hazard ratio ( HR ) 0.94 [ 95 % CI 0.81 - 1.09 ] ) ; between participants allocated vitamin D3 and those who were not ( 353 [ 13.3 % ] of 2649 vs 345 [ 13.1 % ] of 2643 ; 1.02 [ 0.88 - 1.19 ] ) ; or between those allocated combination treatment and those assigned placebo ( 165 [ 12.6 % ] of 1306 vs 179 [ 13.4 % ] of 1332 ; HR for interaction term 1.01 [ 0.75 - 1.36 ] ) . The groups did not differ in the incidence of all-new fractures , fractures confirmed by radiography , hip fractures , death , number of falls , or quality of life . By 24 months , 2886 ( 54.5 % ) of 5292 were still taking tablets , 451 ( 8.5 % ) had died , 58 ( 1.1 % ) had withdrawn , and 1897 ( 35.8 % ) had stopped taking tablets but were still providing data for at least the main outcomes . Compliance with tablets containing calcium was significantly lower ( difference : 9.4 % [ 95 % CI 6.6 - 12.2 ] ) , partly because of gastrointestinal symptoms . However , potentially serious adverse events were rare and did not differ between groups . INTERPRETATION The findings do not support routine oral supplementation with calcium and vitamin D3 , either alone or in combination , for the prevention of further fractures in previously mobile elderly people

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Menatetrenone ameliorates osteopenia in disuse-affected limbs of vitamin D- and K-deficient stroke patients.

Significant reduction in bone mineral density ( BMD ) occurs in stroke patients on the hemiplegic and contralateral sides , correlating with the degree of paralysis and vitamin D and K deficiency due to malnutrition , and increasing the risk of hip fracture . We evaluated the efficacy of vitamin K2 ( menatetrenone : menaquinone-4 ; MK-4 ) in maintaining BMD by comparing serum biochemical indices of bone metabolism between treated and untreated patients . In a r and om and prospect i ve study , of 108 hemiplegic patients following stroke , 54 received 45 mg menatetrenone daily ( MK-4 group , n = 54 ) for 12 months , and the remaining 54 ( untreatment group ) did not . Nine patients excluded from the study . The BMD in the second metacarpals and serum indices of bone metabolism were determined . BMD on the hemiplegic side increased by 4.3 % in the MK-4 group and decreased by 4.7 % in the untreated group ( p < 0.0001 ) , while BMD on the intact side decreased by 0.9 % in the MK-4 group and by 2.7 % in the untreated group ( p < 0.0001 ) . At baseline , patients of both groups showed vitamin D and K1 deficiencies , high serum levels of ionized calcium , pyridinoline cross-linked carboxyterminal telopeptide of type I collagen ( ICTP ) , and low levels of parathyroid hormones ( PTH ) and bone Gla proteins ( BGP ) , indicating that immobilization-induced hypercalcemia inhibits renal synthesis of 1 , 25-dihydroxyvitamin D ( 1 , 25-[OH]2D ) and compensatory PTH secretion . Both vitamins K1 and K2 increased by 97.6 % and 666.9 % , respectively , in the MK-4 group . Correspondingly , a significant increase in BGP and decreases in both ICTP and calcium were observed in the MK-4 group , in association with a simultaneous increase in both PTH and 1 , 25-[OH]2D . One patient in the untreated group suffered from a hip fracture , compared with none in the MK-4 group . The treatment with MK-4 can increase the BMD of disused and vitamin D- and K-deficient hemiplegic bone by increasing the vitamin K concentration , and it also can decrease calcium levels through inhibition of bone resorption , result ing in an increase in 1 , 25-[OH]2D concentration

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

Effect of menatetrenone on bone mineral density and incidence of vertebral fractures in postmenopausal women with osteoporosis: a comparison with the effect of etidronate

Abstract . The purpose of the present study was to compare the effects of etidronate and menatetrenone on bone mineral density ( BMD ) and the incidence of vertebral fractures in postmenopausal women with osteoporosis . Seventy-two osteoporotic women , more than 5 years after menopause , 53–78 years of age , were r and omly divided into three administration groups : E group ; intermittent cyclical etidronate ( 200 mg/day , 14 days per 3 months ; n = 25 ) ; M group ; menatetrenone ( 45 mg/day , daily ; n = 23 ) ; and C group ( control ) ; calcium lactate ( 2 g/day , daily ; n = 24 ) . Forearm BMD was measured by dual-energy X-ray absorptiometry at 0 , 6 , 12 , 18 , and 24 months after the treatment started . There were no significant differences in age , body mass index , years since menopause , and initial BMD among the three groups . One-way analysis of variance ( ANOVA ) with repeated measurements showed a significant decrease in BMD in the C group ( P < 0.0001 ) . Two-way ANOVA with repeated measurements showed a significant increase in BMD in the M group compared with that in the C group ( P < 0.0001 ) , and a significant increase in BMD in the E group compared with that in the C and M groups ( P < 0.0001 and P < 0.01 , respectively ) . The indices of new vertebral fractures/1000 patient-years in the E and M groups were significantly higher than that in the C group ( χ2 = 47.7 ; P < 0.0001 and χ2 = 42.4 ; P < 0.0001 , respectively ) , and did not differ significantly between the E and M groups . The present preliminary study provides evidence to suggest that , despite the lower increase in BMD produced by me-natetrenone , this agent , as well as etidronate , may have the potential to reduce osteoporotic vertebral fractures in postmenopausal women with osteoporosis

This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients

BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

Randomized versus historical controls for clinical trials.

To compare the use of r and omized controls ( RCTs ) and historical controls ( HCTs ) for clinical trials , we search ed the literature for therapies studied by both methods . We found six therapies for which 50 RCTs and 56 HCTs were reported . Forty-four of 56 HCTs ( 79 percent ) found the therapy better than the control regimen , but only 10 of 50 RCTs ( 20 percent ) agreed . For each therapy , the treated patients in RCTs and HCTs of the same therapy was largely due to differences in outcome for the control groups , with HCT control patients generally doing worse than the RCT control groups . Adjustment of the outcomes of the HCTs for prognostic factors , when possible , did not appreciably change the results . The data suggest that biases in patient selection may irretrievably weight the outcome of HCts in favor of new therapies . RCTs may miss clinical ly important benefits because of inadequate attention to sample size . The predictive value of each might be improved by reconsidering the use of p less than 0.05 as the significance level for all types of clinical trials , and by the use of confidence intervals around estimates of treatment effects

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

Secondary Prevention of Low‐Back Pain: A Clinical Trial

A clinical trial , aim ed at secondary prevention of low-back pain , was performed in 142 hospital employees reporting at least three annual episodes of this condition . Participants were r and omly assigned to one of three groups : a calisthenics program ( CAL ) for 3 months with biweekly sessions of flexion exercises , a back school program ( 5 sessions ) , and a control group . The effectiveness of the two intervention programs was evaluated over a 1-year period . Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected . A monthly surveillance for the whole year showed a mean of 4.5 “ painful months ” in the CAL group versus 7.3 and 7.4 months in the back school and control groups , respectively ( P < 0.0001 ) . The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength . The increased trunk flexion was associated with the rate of participation in the CAL sessions . Further research is needed to answer the question of “ intensity versus type of exercise ” by comparing different intervention programs , with similar intensity

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

Effect of Exercise on Sick Leave Due to Low Back Pain: A Randomized, Comparative, Long‐Term Study

Study Design . The study was carried out as an open , r and omized , multicenter , parallel‐group study with an observation period of 12 months . Four Norwegian physiotherapy institutes took part . Patients were subsequently followed for 12 months of home exercise on their own , without the supervision of a physiotherapist . Objectives . 1 ) To investigate and compare the effects of two different exercise programs on low back problems in patients after a 1‐year training program under the supervision of a physiotherapist . 2 ) To investigate the effect supervision by , and motivation from , physiotherapists has on training compliance and efficacy . Summary of Background Data . After ordinary physiotherapy treatment for low back problems , patients were r and omly allocated either to a conventional training program design ed by physiotherapists or to a training program using a new Norwegian‐developed training apparatus called the TerapiMaster . The study included 153 patients with low back problems , all of whom had been referred to physiotherapy by their general practitioners . One hundred twenty‐six patients were followed for an additional 12 months when performing home exercise programs on their own . Methods . Monitoring patient satisfaction with the training program , compliance with the program , and absenteeism from work during the training period . Results . Patient satisfaction with both training programs was high , with about 83 % of participating patients completing the study in accordance with the protocol . Mean absenteeism ( SD ) during the preceding year totaled 82.5 days ( 19.8 ) in the conventional training group and 61.6 days ( 14.7 ) in the TerapiMaster group . Significant reductions to 17.2 days ( 6.0 ) and 15.4 days ( 5.3 ) in the two groups , respectively , were recorded during the training period , corresponding to a 75 % to 80 % reduction compared with the preceding 1‐year period . Mean absenteeism showed a further significant decline during the 12‐month period without supervised training . The average values were 9.9 days ( 3.2 ) for conventional training and 9.3 days ( 3.1 ) for the TerapiMaster , respectively . Conclusions . Both exercise programs reduced absenteeism significantly ( 75‐80 % ) . No difference in the effects of the two different programs was discernible . Regular follow‐up through encouragement and variation in the training programs appear to be important factors for motivating patients to adhere to regular exercise programs for low back problems . This thesis was corroborated by the 12‐month study of unsupervised exercise

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial.

CONTEXT Low back pain is a frequent and costly health problem . Prevention of low back pain is important both for the individual patient and from an economic perspective . OBJECTIVE To assess the efficacy of lumbar supports and education in the prevention of low back pain in industry . DESIGN A r and omized controlled trial with a factorial design . SETTING The cargo department of an airline company in the Netherl and s. PARTICIPANTS A total of 312 workers were r and omized , of whom 282 were available for the 6-month follow-up . INTERVENTIONS Subjects were r and omly assigned to 4 groups : ( 1 ) education ( lifting instructions ) and lumbar support , ( 2 ) education , ( 3 ) lumbar support , and ( 4 ) no intervention . Education consisted of 3 group sessions on lifting techniques with a total duration of 5 hours . Lumbar supports were recommended to be used during working hours for 6 months . MAIN OUTCOME MEASURES Low back pain incidence and sick leave because of back pain during the 6-month intervention period . RESULTS Compliance with wearing the lumbar support at least half the time was 43 % . In the 282 subjects for whom data were available , no statistically significant differences in back pain incidence ( 48 [ 36 % ] of 134 with lumbar support vs 51 [ 34 % ] of 148 without , P=.81 ) or in sick leave because of low back pain ( mean , 0.4 days per month with lumbar support vs 0.4 days without , P=.52 ) were found among the intervention groups . In a subgroup of subjects with low back pain at baseline , lumbar supports reduced the number of days with low back pain per month ( median , 1.2 vs 6.5 days per month ; P=.03 ) . CONCLUSIONS Overall , lumbar supports or education did not lead to a reduction in low back pain incidence or sick leave . The results of the subgroup analysis need to be confirmed by future research . Based on our results , the use of education or lumbar supports can not be recommended in the prevention of low back pain in industry

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

How study design affects outcomes in comparisons of therapy. I: Medical.

We analysed 113 reports published in 1980 in a sample of medical journals to relate features of study design to the magnitude of gains attributed to new therapies over old . Overall we rated 87 per cent of new therapies as improvements over st and ard therapies . The mean gain ( measured by the Mann-Whitney statistic ) was relatively constant across study design s , except for non-r and omized controlled trials with sequential assignment to therapy , which showed a significantly higher likelihood that a patient would do better on the innovation than on st and ard therapy ( p = 0.004 ) . R and omized controlled trials that did not use a double-blind design had a higher likelihood of showing a gain for the innovation than did double-blind trials ( p = 0.02 ) . Any evaluation of an innovation may include both bias and the true efficacy of the new therapy , therefore we may consider making adjustments for the average bias associated with a study design . When interpreting an evaluation of a new therapy , readers should consider the impact of the following average adjustments to the Mann-Whitney statistic : for trials with non-r and om sequential assignment a decrease of 0.15 , for non-double-blind r and omized controlled trials a decrease of 0.11

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

Effect of a general fitness program on musculoskeletal symptoms, clinical status, physiological capacity, and perceived work environment among home care service personnel

The aim of the present controlled study was to evaluate the effect of a general fitness program , performed by an occupational health service , using pre-post assessment for a number of different outcome measures . A total of 160 employees working in the central home care service district of Umeå , Sweden were asked to participate in a program of a 1-year long exercise program . Of the 160 selected , 54 subjects declined to participate and nine subjects were rejected after a medical check up . The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations , question naires concerning sociodemography , musculoskeletal and general health complaints and work environment , physiological tests of cardiovascular fitness , and of strength and endurance of shoulder flexors and knee extensors , and registration of sick leave . The subjects were r and omly assigned to an exercise ( treatment ) or control group . The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination , strength/endurance , and fitness . The test schedule was repeated for both groups after 1 year . The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints , better physiotherapy status ( less muscle tightness , better neck mobility , and less tender points ) , increased shoulder strength and increased coordination in thigh muscles . However , the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment ( i.e. , concerning ergonomy , influence , appreciation and communication with work manager ) , which might have been due to stress associated with the exercise situation

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .

The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.

Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists

The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain

A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain .