The Gary Null Show - 06.22.21

Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS

 University Hospital Wuerzburg (Germany), June 12, 2021

Abstract

The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (r_s = −0.495), PCT (r_s = −0.413), IL-6 (r_s = −0.429), IL-1β (r_s = −0.440) and IL-10 (r_s = −0.461). Positive associations were found for CD8⁺ T cells (r_s = 0.636), NK cells (r_s = 0.772), total IgG (r_s = 0.493) and PaO₂/FiO₂ratios (r_s = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.

 

 

 

Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms

Louisiana State University, June 20, 2021

Insomnia is common in the elderly and is associated with chronic disease, but use of hypnotics increases the incidence of falls. Montmorency tart cherry juice has improved insomnia by self-report questionnaire.

Study Question: 

Is insomnia confirmed by polysomnography and is tryptophan availability a potential mechanism for treating insomnia?

Study Design: 

A placebo-controlled balanced crossover study with subjects older than 50 years and insomnia were randomized to placebo (2 weeks) or cherry juice (2 weeks) (240 mL 2 times/d) separated by a 2-week washout.

Measures and Outcomes: 

Sleep was evaluated by polysomnography and 5 validated questionnaires. Serum indoleamine 2,3-dioxygenase (IDO), the kynurenine-to-tryptophan ratio, and prostaglandin E2 were measured. In vitro, Caco-2 cells were stimulated with interferon-gamma, and the ability of cherry juice procyanidin to inhibit IDO which degrades tryptophan and stimulates inflammation was measured. The content of procyanidin B-2 and other major anthocyanins in cherry juice were determined.

Results: 

Eleven subjects were randomized; 3 with sleep apnea were excluded and referred. The 8 completers with insomnia increased sleep time by 84 minutes on polysomnography (P = 0.0182) and sleep efficiency increased on the Pittsburgh Sleep Quality Index (P = 0.03). Other questionnaires showed no significant differences. The serum kynurenine-to-tryptophan ratio decreased, as did the level of prostaglandin E2 (both P < 0.05). In vitro, cherry juice procyanidin B-2 dose-dependently inhibited IDO.

Conclusions: 

Cherry juice increased sleep time and sleep efficiency. Cherry juice procyanidin B-2 inhibited IDO, increased tryptophan availability, reduced inflammation, and may be partially responsible for improvement in insomnia.

 

 

 

 

Many with migraines have vitamin deficiencies, says study

 

Cincinnati Children’s Hospital, June 10, 2021 

 

A high percentage of children, teens and young adults with migraines appear to have mild deficiencies in vitamin D, riboflavin and coenzyme Q10—a vitamin-like substance found in every cell of the body that is used to produce energy for cell growth and maintenance.

 

These deficiencies may be involved in patients who experience migraines, but that is unclear based on existing studies.

 

"Further studies are needed to elucidate whether vitamin supplementation is effective in migraine patients in general, and whether patients with mild deficiency are more likely to benefit from supplementation," says Suzanne Hagler, MD, a Headache Medicine fellow in the division of Neurology at Cincinnati Children's Hospital Medical Center and lead author of the study.

 

Dr. Hagler and colleagues at Cincinnati Children's conducted the study among patients at the Cincinnati Children's Headache Center. She will present her findings at 9:55 am Pacific time Friday, June 10, 2016 at the 58th Annual Scientific Meeting of the American Headache Society in San Diego.

 

Dr. Hagler's study drew from a database that included patients with migraines who, according to Headache Center practice, had baseline blood levels checked for vitamin D, riboflavin, coenzyme Q10 and folate, all of which were implicated in migraines, to some degree, by previous and sometimes conflicting studies. Many were put on preventive migraine medications and received vitamin supplementation, if levels were low. Because few received vitamins alone, the researchers were unable to determine vitamin effectiveness in preventing migraines.

 

She found that girls and young woman were more likely than boys and young men to have coenzyme Q10 deficiencies at baseline. Boys and young men were more likely to have vitamin D deficiency. It was unclear whether there were folate deficiencies. Patients with chronic migraines were more likely to have coenzyme Q10 and riboflavin deficiencies than those with episodic migraines.

 

Previous studies have indicated that certain vitamins and vitamin deficiencies may be important in the migraine process. Studies using vitamins to prevent migraines, however, have had conflicting success.

 

 

Research suggests mask-wearing can increase struggles with social anxiety

University of Waterloo (Canada), June 21, 2021

People who struggle with social anxiety might experience increased distress related to mask-wearing during and even after the COVID-19 pandemic.

A paper authored by researchers from the University of Waterloo's Department of Psychology and Centre for Mental Health Research and Treatment also has implications for those who haven't necessarily suffered from social anxiety in the past.

"The adverse effects of the COVID-19 pandemic on mental health outcomes, including anxiety and depression, have been well-documented," said David Moscovitch, professor of clinical psychology and co-author of the paper. "However, little is known about effects of increased mask-wearing on social interactions, social anxiety, or overall mental health.

"It is also possible that many people who didn't struggle with social anxiety before the pandemic may find themselves feeling more anxious than usual as we emerge out of the pandemic and into a more uncertain future -- especially within social situations where our social skills are rusty and the new rules for social engagement are yet to be written."

Social anxiety is characterized by negative self-perception and fear that one's appearance or behaviour will fail to conform with social expectations and norms. Social anxiety disorder is an extreme manifestation that affects up to 13 per cent of the population. 

The researchers reviewed existing literature addressing three factors that they hypothesized might contribute to social anxiety associated with mask-wearing: hypersensitivity to social norms, bias in the detection of social and emotional facial cues, and propensity for self-concealment as a form of safety behaviour.

"We found that mask-wearing by people with social anxiety is likely to be influenced by their perception of social norms and expectations, which may or may not be consistent with public-health guidelines and can vary widely by region and context," said Sidney Saint, an undergraduate psychology student at Waterloo and lead author of the paper.

The paper also highlights that people with social anxiety have difficulty detecting ambiguous social cues and are likely to interpret them negatively. These individuals also tend to worry about sounding incomprehensible or awkward. "We believe that both issues are likely to be magnified during interactions with masks," Saint said.

Another highlighted impact is that masks can function as a type of self-concealment strategy that enables people with social anxiety to hide their self-perceived flaws. Therefore, the desire for self-concealment may motivate their use of masks over and above their desire to protect themselves from contagion. "Due to their self-concealing function, masks may be difficult for some people to discard even when mask-wearing is no longer required by public health mandates," Saint said. 

In addition to contributing insights to guide clinicians toward effective assessment and treatment, the paper shows that people with social anxiety may be particularly vulnerable to periods of norm transitions where expectations for mask-wearing are in flux or become a matter of personal choice.

 

 

 

Going with your gut can result in better decision-making than using detailed data methods, study shows

City University London, June 21, 2021

Managers who use their gut instinct together with simple decision-making strategies may make equally good, but faster, decisions as those who use data to reach an outcome, a new study has found.

The report, co-authored by academics at the Business School (formerly Cass), King's Business School, and the University of Malta, finds that the reliance on data analysis in decision-making might be counterproductive as this reduces decision-making speed without ensuring more accuracy.

The research, based on information from 122 advertising, digital, publishing, and software companies, finds that using data to inform decision making under high uncertainty is often not optimal. This may explain why 12 different publishers initially rejected the opportunity to publish "Harry Potter and the Philosopher's Stone' – because it had no data to inform its potential.

A recent survey revealed that 92 percent of Fortune 1000 companies were reporting increased investment in data initiatives, although it appears this may not always be necessary.

The authors asked managers how they made decisions on their most recent innovation project, including the extent to which they used data, instinct, and other simple heuristics (mental strategies). The findings outlined that among those decision-making methods were:

1. Majority—choosing what the most people wanted
2. Tallying—picking the choice with the greatest quantity of positive points
3. Experience—selecting the option that the most experienced individual on the team wanted.

Managers were asked whether they think they made the right decision and how fast they were in reaching that decision. Results showed that managers relied on their own instinct as much as data, using 'tallying' more than any other metric.

Dr. Oguz A. Acar, Reader in Marketing at the Business School and co-author of the report, said: "This research shows that data-driven decision-making is not the panacea in all situations and may not result in increased accuracy when facing uncertainty.

"Under extreme uncertainty, managers, particularly those with more experience, should trust the expertise and instincts that have propelled them to such a position. The nous developed over years as a leader can be a more effective than an analytical tool which, in situations of extreme uncertainty, could act as a hindrance rather than a driver of success."

"Choosing among alternative new product development projects: The role of heuristics" is published in Psychology and Marketing.

 

Pretreatment by rosemary extract or cell transplantation improves memory deficits of Parkinson disease

Damghan University (Iran) June 21 2021

According to news originating from Damghan, Iran, research stated, “The therapeutic effect of adipose tissue-derived stem cells (ADSCs) or RE on hippocampal neurogenesis and memory in Parkinsonian rats were investigated. Male rats were lesioned by bilateral intra-nigral injections of 6-OHDA and divided into six groups: 1. Lesion 2 and 3: RE and water groups were lesioned rats pretreated with RE or water, from 2weeks before neurotoxin injection and treated once a day for 8weeks post lesion. 4&5: Cell and alpha-MEM (alpha-minimal essential medium) received intravenous injection of BrdU-labeled ADSCs or medium, respectively from 10days post lesion until 8weeks later. 6: Sham was injected by saline instead of neurotoxin.”

Our news journalists obtained a quote from the research from Damghan University, “Memory was assessed using Morris water Maze (MWM), one week before and at 1, 4 and 8weeks post 6-OHDA lesion. After the last probe, the animals were sacrificed and brain tissue obtained. Paraffin sections were stained using cresyl violet, anti-BrdU (Bromodeoxyuridine / 5-bromo-2’-deoxyuridine), anti-GFAP (Glial fibrillary acidic protein) and anti-TH antibodies. There was a significant difference of time spent in the target quadrant between groups during probe trial at 4 and 8 weeks’ post-lesion. Cell and RE groups spent a significantly longer period in the target quadrant and had lower latency as compared with lesion. Treated groups have a significantly higher neuronal density in hippocampus compared to water, alpha-MEM and lesion groups. BrdU positive cells were presented in lesioned sites. The GFAP (Glial fibrillary acidic protein) positive cells were reduced in treated and sham groups compared to the water, alpha-MEM and lesion groups.”

According to the news editors, the research concluded: “Oral administration of RE (Rosemary extract) or ADSCs injection could improve memory deficit in the Parkinsonian rat by neuroprotection.”

 

 

Inadequate vitamin D levels associated with interstitial lung disease

Johns Hopkins University, June 20 2021. 

 

An article appearing in the Journal of Nutrition documents a link between decreased vitamin D levels and a greater risk of early signs of interstitial lung disease (ILD), a group of disorders characterized by inflammation and scarring that can lead to lung damage. Although ILD can be caused by environmental and other factors, some cases have unknown causes.

The investigation included 6,302 participants in the Multi-Ethnic Study of Atherosclerosis who had information available concerning their initial serum 25-hydroxyvitamin D concentrations and computed tomography (CT) imaging that included partial views of the lungs. Ten years after enrollment, 2,668 participants had full lung CT scans that were evaluated for presence of scar tissue and other abnormalities.

Subjects who had deficient vitamin D levels of less than 20 ng/mL had more spots on their lungs that were suggestive of damage in comparison with subjects whose vitamin D was adequate. Among those who had full lung CT scans, deficient or intermediate (between 20-30 ng/mL) vitamin D levels were associated with a 50-60% greater risk of abnormalities suggestive of ILD.

"We knew that the activated vitamin D hormone has anti-inflammatory properties and helps regulate the immune system, which goes awry in ILD," commented senior author Erin Michos, MD, MHS. “There was also evidence in the literature that vitamin D plays a role in obstructive lung diseases such as asthma and COPD, and we now found that the association exists with this scarring form of lung disease too."

"Our study suggests that adequate levels of vitamin D may be important for lung health,” she concluded. “We might now consider adding vitamin D deficiency to the list of factors involved in disease processes, along with the known ILD risk factors such as environmental toxins and smoking.”