Inflammation

Milk fat globule membrane

Effect of Milk Fat Globule Membrane (MFGM) on Gut Barrier Protection in Runners

In this outcome, the barrier properties of the gut are assessed indirectly. Subjects consume a mixture of lactulose and mannitol. Mannitol is a monosaccharide and is passively absorbed from the gut and eliminated via the urine. Lactulose, on the other hand, is an indigestible disaccharide. If it appears in the urine, it is thought to pass into the body through loose tight junctions between the mouth and large intestine. If it reaches the large intestine, lactulose will be fermented by the microbiome.
Subjects consume the sugar mixture and urine is collected for 6 hours. In this study, gut permeability was measured at baseline, and after after the running tests.

Higher core temperatures are associated with increased gut permeability. Two of our primary measures were gut permeability assessments by the differential sugar test and plasma LPS. The increase in core temperature was included to give context to those measures. Prior to the exercise test, subjects consumed a thermometer pill and core temperature was monitored with a recording device.

Plasma lactate was measured as an index of exercise intensity. It was measured before the exercise challenge, and immediately after. It was also measured at 1 hour and 4 hours post exercise.

To determine the systemic inflammatory response, plasma cytokines were measured before the exercise test and at 1h and 5h later. Plasma cytokines were measured with a multiplexed ELISA kit.

Higher levels of plasma endotoxin (aka LPS) are thought to occur due to a leaky gut

Creatine kinase was measured as an index of muscle stress. It was measured before the exercise challenge, and immediately after. It was also measured at 1 hour and 4 hours post exercise.

Robert Ward

Associate Professor

Utah State University

Dairy Research Institute

When the patient has been randomized to either group, a licensed provider under the direction of the PI, will utilize the ultrasound to identify the inferior tibiofibular ligament (syndesmotic ligament). This provider that performs the injection will not be involved in any follow-up visits or return to play review. When appropriate positioning is confirmed the area will be injected with a mixture of 5 ml of 0.25 % bupivacaine hydrochloride and 2 ml of 3 mg/ml betamethasone sodium phosphate (Celestone® Soluspan®) (BTM)

When the patient has been randomized to either group, a licensed provider under the direction of the PI, will utilize the ultrasound to identify the inferior tibiofibular ligament (syndesmotic ligament). This provider that performs the injection will not be involved in any follow-up visits or return to play review. When appropriate positioning is confirmed, the area will be injected with 5ml of bupivacaine hydrochloride.

Ankle Injuries

5ml of 0.25% bupivacaine hydrochloride and 2 ml of 3mg/ml betamethasone sodium phosphate one injection into the inferior tibiofibular ligament

bupivacaine hydrochloride and betamethasone sodium phosphate

5ml of bupivacaine hydrochloride into the tibiofibular ligament

bupivacaine hydrochloride

Sanford Orthopedics and Sports Medicine

Investigation of Corticosteroid Versus Placebo Injection in Patients With Syndesmotic Ligament Injury or High Ankle Sprain

Single-site, Double Blinded, Randomized Investigation of Corticosteroid Versus Placebo Injection Under Ultrasound Guidance in Patients With Syndesmotic Ligament Injury or High Ankle Sprain

Sanford Health

Patients with moderate-to-severe Acute Respiratory Distress Syndrome treated solely with lung protective, low volume high positive end-expiratory pressure conventional mechanical ventilation (CMV) and recruitment maneuvers, as specified in detail in the Detailed Description section.

Patients with moderte-to-severe Acute Respiratory Distress Syndrome treated initially with a 96-hour-lasting session (session duration modifiable according to oxygenation criteria) of High-frequency oscillation (HFO)-Recruitment Maneuvers (RMs), and then with lung protective CMV interspersed to additional HFO-RMs sessions (if required according to study protocol). The protocolized use of HFO-RMs may extend until day 10 post-randomization, according to pre-specified oxygenation criteria. Full details are provided in the Detailed Description Section.

Acute Respiratory Distress Syndrome

Low tidal volume-high positive end-expiratory pressure conventional mechanical ventilation (CMV) and recruitment maneuvers, as specified in detail in the Detailed Description Section.

Lung protective CMV

Initial, 96-hour-lasting session (session duration modifiable according to oxygenation criteria) of High-frequency oscillation (HFO) combined with recruitment Maneuvers (RMs), followed by additional HFO-RMs sessions (if required according to the study protocol oxygenation criteria)during days 1-10. During the rest of the intervention period, patients will be treated with the same lung protective CMV strategy of the CMV arm. Additional details are provided in the Detailed Description Section.

HFO-RMs

Evaggelismos General Hospital

Larisa University General Hospital

High Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome (ARDS)

Effect of Intermittent High Frequency Oscillatory Ventilation on the Pathophysiology and Survival of Patients With the Acute Respiratory Distress Syndrome.

Patient discharged home while not requiring any form of ventilatory assistance.

"60 minus days on ventilator until day 60 postrandomization"

"60 minus the days with an organ failure until day 60 postrandomization"

Ventilation-related (e.g. barotrauma); Recruitment Maneuver-related (e.g. hypotension or desaturation); Tracheal Gas Insufflation-related (e.g. tracheal mucosal damage)

Evolution of Physiological variables during the first 10 days post-randomization {comparison of gas-exchange, respiratory mechanics (14), hemodynamics, fluid balance of preceding 24 hours, and blood lactate; all between-group-compared variables to be concurrently determined within 8.30 to 9.00 a.m. of each one of the first 10 days post-randomization}

Determination of markers of inflammation (cytokines and Activin A) in bronchoalveolar lavage fluid and peripheral blood at baseline and on day 5 post-randomization. Additional determination of surfactant activity on the same time points.

Spyros D. Mentzelopoulos

Assistant Professor in Intensive Care Medicine

University of Athens

University of Thessaly

Thoracic Surgery

Cardiac Surgery

Cardiopulmonary Bypass

Oral Impact (preoperative enteral nutritional supplement)

Cardiopulmonary Surgery, Academic Medical Center

Immunonutrition in Cardiac Surgery

The Effect of Pre- and Postoperative Supplemental Enteral Nutrition in High-Risk Patients Undergoing Elective Cardiac Surgery. A Prospective Double Blind Study.

phospholipid/hypoxia

Effect of Milk Fat Globule Membrane (MFGM) on Gut Barrier Protection in Runners

Investigation of Corticosteroid Versus Placebo Injection in Patients With Syndesmotic Ligament Injury or High Ankle Sprain

High Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome (ARDS)

Immunonutrition in Cardiac Surgery

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