Lung TransplantationNCT06249334
Whole-Body Electrical Stimulation in Patients Undergoing Lung Transplantation
A study testing Whole-body electrical stimulation and Routine physical therapy in people with Lung Transplantation and Electric Stimulation, run by Federal University of Health Science of Porto Alegre at 1 site in Brazil.
Trial summary
This study aims to evaluate the effects of whole-body electrical stimulation (WB-EMS) in the rehabilitation of patients undergoing lung transplantation. This is a randomized clinical trial with patients from the inpatient unit of Dom Vicente Scherer Hospital of Irmandade Santa Casa de Misericórdia from Porto Alegre… Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Lung Transplantation, Electric Stimulation
- What is being tested?
- Whole-body electrical stimulation and Routine physical therapy
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 26 participants
- Where
- 1 siteBrazil
- Study dates
- 20 Dec 2024to Aug 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients undergoing unilateral or bilateral lung transplantation;
- Admitted to the intensive care unit and without invasive ventilatory support;
- Hemodynamically stable;
- Time less than or equal to 7 days between lung transplantation and the beginning of rehabilitation protocols.
Who cannot join
- Patients with severe psychomotor agitation;
- Recent acute myocardial infarction (24 hours) and / or uncontrolled arrhythmias;
- Temporary transcutaneous pacemaker;
- Stroke after lung transplantation;
- Decompensated heart failure;
- Uncontrolled hypertension (systolic blood pressure > 230 mmHg and diastolic blood pressure > 120 mmHg) or mean arterial pressure <60 mmHg;
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- Patients who present important hemodynamic changes during training;
- Peripheral vascular changes in the lower limbs such as untreated deep vein thrombosis;
- In a feverish state;
- Patients with epidermal lesions on the thighs that make it impossible to place self-adhesive electrodes for electrical stimulation;
- Patients with acute renal failure.
Trial locations and contacts
1 site in 1 country.
Brazil1 site
Federal University of Health Sciences of Porto Alegre
Porto Alegre, Rio Grande Do Sul (RS), 90050170
Jociane DM Schardong, PhD, +5555981348114, joci_fisioufsm@yahoo.com.br
About this study
Official title: Whole-Body Electrical Stimulation in Patients Undergoing Lung Transplantation: Randomized Clinical Trial
This study aims to evaluate the effects of whole-body electrical stimulation (WB-EMS) in the rehabilitation of patients undergoing lung transplantation. This is a randomized clinical trial with patients from the inpatient unit of Dom Vicente Scherer Hospital of Irmandade Santa Casa de Misericórdia from Porto Alegre (ISCMPA) who will be allocated to a control group (which will receive physiotherapy from routine) or intervention group (which will receive physiotherapy from routine and WB-EMS). Interventions with WB-EMS will occur every day from the moment of extubation until hospital discharge (15 sessions per patient). Assessments will be carried out pre-lung transplantation, after extubation, during intervention protocols and at the time of hospital discharge.
Read the detailed description
Patients on the lung transplant list may experience post-procedure complications that culminate in a higher risk of mortality, which are related to primary and chronic graft dysfunction and infections. These complications are partly responsible for prolonged immobility, sarcopenia, decline in functional capacity and deterioration in quality of life. There is evidence that physical rehabilitation, mainly through exercise, improves the physical capacity and quality of life of transplant patients. However, not all patients are able to perform this type of activity due to low tolerance for it. In this sense, WB-EMS can be an alternative for early rehabilitation. This study aims to evaluate the effects of WB-EMS in the rehabilitation of patients undergoing lung transplantation.
Patients will be selected from the Pulmonary Rehabilitation Center of Pereira Filho Hospital prior to lung transplantation and the following assessments will be carried out: muscle architecture and quality (ultrasound), peripheral muscle strength (dynamometry of lower and upper limbs, Medical Research Council scale and 10-repetition sit-and-stand test), respiratory muscle strength (manovacuometry) and functional capacity (six-minute walk test). After the transplant, with the patient admitted to the intensive care unit, and after being extubated, blood sample will be collected to measure muscle damage, also it will be evaluated the muscle architecture and quality, peripheral muscle strength (only using the Medical Research Council scale) and respiratory muscle strength. Prior to hospital discharge, muscle architecture and quality, peripheral muscle strength (dynamometry of lower and upper limbs, Medical Research Council scale and 10-repetition sit-and-stand test), respiratory muscle strength, functional capacity, and muscle damage will be reassessed, along with the length of hospital stay.
During the training period, the safety of the therapy will be assessed by monitoring cardiorespiratory parameters, muscle pain (analogic visual scale) and fatigue (Borg subjective perceived exertion scale).
Patients will be randomized to the control group (GC) (which will receive physiotherapy from routine) or the intervention group (GI), which will perform whole-body electrical stimulation using the equipment ReCARE® (Visuri, Minas Gerais, Brazil), in addition to routine physiotherapy. After extubation, patients will begin the protocol for 15 sessions and will be reevaluated, therefore the protocol begins in the intensive care unit and will be completed in the inpatient unit.
- Conditions
- Lung Transplantation, Electric Stimulation
- Being tested
- Whole-body electrical stimulation, Routine physical therapy
- Keywords
- Lung transplantation, Electric stimulation, Randomized Controlled Trial
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Whole-body electrical stimulationOther
Also called Whole-body electromyostimulation
The protocol with whole-body electrical stimulation will begin in the intensive care unit and will be completed in the inpatient unit. To stimulate all proposed muscle groups, self-adhesive electrodes will be positioned bilaterally on the quadriceps femoris, tibialis anterior, biceps brachii and lower rectus abdominis muscles. The frequency of 75 Hz will be adopted and the intensity will be adjusted to cause visible muscle contraction. The progression of the therapy protocol will occur throughout the sessions aiming to reach 20 minutes of therapy and 80 contractions.
Routine physical therapyOther
The protocol will be based on knee and hip flexion and extension movements; hip adduction and abduction; flexion and extension of shoulders, elbows and wrists; shoulder abduction and adduction; respecting the range of each joint. Volunteers will also perform transfers from lying to sitting and standing positions. Respiratory conduct will be based on ventilation patterns, bronchial hygiene maneuvers and cough.
| Study group | Role | What they receive |
|---|---|---|
| Whole-body electrical stimulation (WB-EMS) | Experimental | WB-EMS will be performed with ReCare® equipment (Visuri, Minas Gerais, Brazil). Patients will perform sessions once a day, totaling a maximum of 15 sessions. In addition to the WB-EMS protocol, the patients will receive routine physiotherapy at the hospital. Receives: Other: Whole-body electrical stimulation |
| Routine physical therapy | Active comparator | Patients in the control group (active comparator) will receive routine hospital physical therapy until the moment of hospital discharge.
No intervention with electrical stimulation will be performed in this group. Receives: Other: Routine physical therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Isometric quadriceps muscle strength.
Isometric quadriceps muscle strength will be evaluated using a portable dynamometer.
Measured: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Lower limb muscle strength.
Lower limb strength will be carried out using the 10-repetition sit-and-stand test (SST).
Measured: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Mortality.
Mortality will be assessed by counting the number of deaths occurring in the study and after hospital discharge.
Measured: Mortality will be assessed after 30 days, after 60 days and up to 1 year after lung transplantation.
Secondary outcomes (14)
Safety of whole-body electrical stimulation.
Safety of whole-body electrical stimulation will be assessed by measuring peripheral oxygen saturation.
Measured: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Safety of whole-body electrical stimulation.
Safety of whole-body electrical stimulation will be assessed by measuring heart rate.
Measured: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Safety of whole-body electrical stimulation.
Safety of whole-body electrical stimulation will be assessed by measuring blood pressure.
Measured: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Muscle pain.
Muscle pain will be measured with the analogic visual scale (AVS). This scale classifies pain from 0 (not at all) to 10 (maximum).
Measured: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Safety of whole-body electrical stimulation.
Safety of whole-body electrical stimulation will be assessed by perceived exertion with the modified Borg Scale.This scale classifies effort from 0 (nothing at all) to 10 (maximum).
Measured: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Isometric muscle strength of the elbow flexors.
The muscle strength of the upper limbs will be assessed through isometric contraction of the elbow flexor muscles with a portable dynamometer.
Measured: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Upper limb muscle strength.
Palmar handgrip will also be assessed using an analog hydraulic dynamometer.
Measured: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Overall muscle strength.
To assess global muscle strength, the Medical Research Council (MRC) scale will be used. The total score ranges from 0 (quadriplegia) to 60 points (preserved muscle strength).
Measured: Time 0 (baseline), on the first day after extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Respiratory muscle strength.
Respiratory muscle strength will be measured using the digital manovacuometer.
Measured: Time 0 (baseline), on the first day after extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Muscle architecture.
The muscle architecture will be evaluated for the acquisition of ultrasound images of the vastus lateralis, rectus femoris, biceps brachii and rectus abdominis muscles, using a high-resolution ultrasound.
Measured: Time 0 (baseline), on the first day after extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Functional capacity.
Functional capacity will be assessed using the six-minute walk test (6MWT).
Measured: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Muscle damage.
Muscle damage will be assessed by dosage of creatine phosphokinase.
Measured: On the first day post extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Muscle damage.
Muscle damage will be assessed by dosage of lactate dehydrogenase.
Measured: On the first day post extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Length of hospital stay.
Length of hospital stay will be based on the number of days between the date of admission and hospital discharge.
Measured: From randomization to discharge or death from any cause, whichever comes first, assessed up to 3 months.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Feb 2024
- Study start20 Dec 2024 (estimated)
- Primary completionApr 2025 (estimated)
- Study completionAug 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Lung TransplantationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 26 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Federal University of Health Science of Porto Alegre
- Sponsor type
- University, hospital or other
- Collaborators
- Irmandade Santa Casa de Misericórdia de Porto Alegre
- Responsible party
- Principal investigator, Jociane Schardong, Federal University of Health Science of Porto Alegre
- Investigators
- Jociane Schardong, PhD, Principal investigator, Federal University of Health Sciences of Porto Alegre
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06249334
- Sponsor's protocol ID
- WBES_LT
- Status last verified
- Feb 2024
- First submitted
- 29 Nov 2023
- Last updated
- 18 Dec 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Garlet AB, Plentz RDM, Righi NC, Schardong J. Whole-body electrical stimulation in patients undergoing lung transplantation in Southern Brazil: study protocol of a single-center randomized controlled trial. Trials. 2025 Dec 5;27(1):23. doi: 10.1186/s13063-025-09177-y.
PubMed 41350869
Study at a glance
From the registry record, last updated by the sponsor on 18 Dec 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Whole-Body Electrical Stimulation in Patients Undergoing Lung Transplantation: Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT06249334
- Acronym / sponsor ID
- WBES_LT
- Conditions
- Lung Transplantation, Electric Stimulation
- Keywords
- Lung transplantation, Electric stimulation, Randomized Controlled Trial
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 26 participants (estimated)
- Lead sponsor
- Federal University of Health Science of Porto AlegreUniversity, hospital or other
- Collaborators
- Irmandade Santa Casa de Misericórdia de Porto Alegre
- Study start
- 20 Dec 2024 (estimated)
- Primary completion
- Apr 2025 (estimated)
- Study completion
- Aug 2025 (estimated)
- First posted
- 8 Feb 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to evaluate the effects of whole-body electrical stimulation (WB-EMS) in the rehabilitation of patients undergoing lung transplantation. This is a randomized clinical trial with patients from the inpatient unit of Dom Vicente Scherer Hospital of Irmandade Santa Casa de Misericórdia from Porto Alegre (ISCMPA) who will be allocated to a control group (which will receive physiotherapy from routine) or intervention group (which will receive physiotherapy from routine and WB-EMS). Interventions with WB-EMS will occur every day from the moment of extubation until hospital discharge (15 sessions per patient). Assessments will be carried out pre-lung transplantation, after extubation, during intervention protocols and at the time of hospital discharge.
Detailed description
Patients on the lung transplant list may experience post-procedure complications that culminate in a higher risk of mortality, which are related to primary and chronic graft dysfunction and infections. These complications are partly responsible for prolonged immobility, sarcopenia, decline in functional capacity and deterioration in quality of life. There is evidence that physical rehabilitation, mainly through exercise, improves the physical capacity and quality of life of transplant patients. However, not all patients are able to perform this type of activity due to low tolerance for it. In this sense, WB-EMS can be an alternative for early rehabilitation. This study aims to evaluate the effects of WB-EMS in the rehabilitation of patients undergoing lung transplantation.
Patients will be selected from the Pulmonary Rehabilitation Center of Pereira Filho Hospital prior to lung transplantation and the following assessments will be carried out: muscle architecture and quality (ultrasound), peripheral muscle strength (dynamometry of lower and upper limbs, Medical Research Council scale and 10-repetition sit-and-stand test), respiratory muscle strength (manovacuometry) and functional capacity (six-minute walk test). After the transplant, with the patient admitted to the intensive care unit, and after being extubated, blood sample will be collected to measure muscle damage, also it will be evaluated the muscle architecture and quality, peripheral muscle strength (only using the Medical Research Council scale) and respiratory muscle strength. Prior to hospital discharge, muscle architecture and quality, peripheral muscle strength (dynamometry of lower and upper limbs, Medical Research Council scale and 10-repetition sit-and-stand test), respiratory muscle strength, functional capacity, and muscle damage will be reassessed, along with the length of hospital stay.
During the training period, the safety of the therapy will be assessed by monitoring cardiorespiratory parameters, muscle pain (analogic visual scale) and fatigue (Borg subjective perceived exertion scale).
Patients will be randomized to the control group (GC) (which will receive physiotherapy from routine) or the intervention group (GI), which will perform whole-body electrical stimulation using the equipment ReCARE® (Visuri, Minas Gerais, Brazil), in addition to routine physiotherapy. After extubation, patients will begin the protocol for 15 sessions and will be reevaluated, therefore the protocol begins in the intensive care unit and will be completed in the inpatient unit.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Whole-body electrical stimulation (WB-EMS) | Experimental | Other: Whole-body electrical stimulationWB-EMS will be performed with ReCare® equipment (Visuri, Minas Gerais, Brazil). Patients will perform sessions once a day, totaling a maximum of 15 sessions. In addition to the WB-EMS protocol, the patients will receive routine physiotherapy at the hospital. |
| Routine physical therapy | Active comparator | Other: Routine physical therapyPatients in the control group (active comparator) will receive routine hospital physical therapy until the moment of hospital discharge. No intervention with electrical stimulation will be performed in this group. |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Patients undergoing unilateral or bilateral lung transplantation;
- Admitted to the intensive care unit and without invasive ventilatory support;
- Hemodynamically stable;
- Time less than or equal to 7 days between lung transplantation and the beginning of rehabilitation protocols.
Key exclusion criteria (11 listed)
- Patients with severe psychomotor agitation;
- Recent acute myocardial infarction (24 hours) and / or uncontrolled arrhythmias;
- Temporary transcutaneous pacemaker;
- Stroke after lung transplantation;
- Decompensated heart failure;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Whole-body electrical stimulationAlso: Whole-body electromyostimulationThe protocol with whole-body electrical stimulation will begin in the intensive care unit and will be completed in the inpatient unit. To stimulate all proposed muscle groups, self-adhesive electrodes will be positioned bilaterally on the quadriceps femoris, tibialis anterior, biceps brachii and lower rectus abdominis muscles. The frequency of 75 Hz will be adopted and the intensity will be adjusted to cause visible muscle contraction. The progression of the therapy protocol will occur throughout the sessions aiming to reach 20 minutes of therapy and 80 contractions. | Other | Whole-body electrical stimulation (WB-EMS) |
| Routine physical therapyThe protocol will be based on knee and hip flexion and extension movements; hip adduction and abduction; flexion and extension of shoulders, elbows and wrists; shoulder abduction and adduction; respecting the range of each joint. Volunteers will also perform transfers from lying to sitting and standing positions. Respiratory conduct will be based on ventilation patterns, bronchial hygiene maneuvers and cough. | Other | Routine physical therapy |
Primary outcome
Isometric quadriceps muscle strength.
Time frame: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Isometric quadriceps muscle strength will be evaluated using a portable dynamometer.
Lower limb muscle strength.
Time frame: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Lower limb strength will be carried out using the 10-repetition sit-and-stand test (SST).
Mortality.
Time frame: Mortality will be assessed after 30 days, after 60 days and up to 1 year after lung transplantation.
Mortality will be assessed by counting the number of deaths occurring in the study and after hospital discharge.
14 secondary outcomes
Safety of whole-body electrical stimulation.
Time frame: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Safety of whole-body electrical stimulation.
Time frame: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Safety of whole-body electrical stimulation.
Time frame: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Muscle pain.
Time frame: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Safety of whole-body electrical stimulation.
Time frame: Time 0 (pre intervention), after 10 minutes and at 20 minutes from the beginning of the intervention.
Isometric muscle strength of the elbow flexors.
Time frame: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Upper limb muscle strength.
Time frame: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Overall muscle strength.
Time frame: Time 0 (baseline), on the first day after extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Respiratory muscle strength.
Time frame: Time 0 (baseline), on the first day after extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Muscle architecture.
Time frame: Time 0 (baseline), on the first day after extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Functional capacity.
Time frame: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).
Muscle damage.
Time frame: On the first day post extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Muscle damage.
Time frame: On the first day post extubation and immediately after 15 sessions (totaling a maximum of 3 weeks).
Length of hospital stay.
Time frame: From randomization to discharge or death from any cause, whichever comes first, assessed up to 3 months.
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Dec 2024.
- Derived from this study: PubMed 41350869Garlet AB, Plentz RDM, Righi NC, Schardong J. Whole-body electrical stimulation in patients undergoing lung transplantation in Southern Brazil: study protocol of a single-center randomized controlled trial. Trials. 2025 Dec 5;27(1):23. doi: 10.1186/s13063-025-09177-y.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Jociane Schardong, PhD principal investigator
Federal University of Health Sciences of Porto Alegre
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Whole-body electrical stimulation and Routine physical therapy in people with Lung Transplantation and Electric Stimulation, run by Federal University of Health Science of Porto Alegre at 1 site in Brazil.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 18 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Jociane Schardong, PhD (+55 55981348114, joci_fisioufsm@yahoo.com.br), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Isometric quadriceps muscle strength. (time frame: Time 0 (baseline) and immediately after 15 sessions (totaling a maximum of 3 weeks).). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06249334, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Dec 2024.