Purpose
To evaluate the impact of high-intensity interval training (HIIT) on health-related outcome parameters in the prehabilitation of patients diagnosed with cancer.
Methods
A systematic review ...and meta-analysis of comparative studies on HIIT in cancer prehabilitation conducted by screening standard databases from their inception to March 30, 2020. Outcomes of interest included cardiorespiratory fitness, feasibility, safety, clinical, and patient-reported outcomes.
Results
Of the 855 identified studies, 8 articles met the inclusion criteria (7 randomized, 1 non-randomized controlled trial) with a total of 896 patients. The study protocols were heterogeneous, but the methodological quality ranged from good to high according to PEDro scale. Meta-analysis revealed a significant improvement of peak oxygen consumption (VO
2
peak) achieved with HIIT compared to usual care. Furthermore, HIIT was feasible and safe, showing low risk of adverse events and positive effects on health-related outcomes in prehabilitative settings.
Conclusion
In the phase of prehabilitation, HIIT has potential health benefits in patients diagnosed with cancer and is feasible and safe to perform. Nonetheless, larger randomized controlled trials focusing on long-term effects (such as cancer recurrence or survival rates) are missing, to underline the potential relevance of HIIT for cancer patients.
Background
The purpose of this systematic review update and meta-analysis was to analyze resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast ...cancer-related lymphedema (BCRL) status and upper and lower extremity strength.
Methods
Systematic literature search was conducted utilizing PubMed, MEDLINE, and Embase databases. Any exercise intervention studies—both randomized controlled and uncontrolled—which assessed the effects of RE on BCRL in BCS in at least one intervention group published between 1966 and 31st January 2020 were included. Included articles were analyzed regarding their level of evidence and their methodological quality using respective tools for randomized and nonrandomized trials of the Cochrane collaboration. Meta-analysis for bioimpedance spectroscopy (BIS) values as well as upper and lower extremity strength was conducted.
Results
Altogether, 29 studies were included in the systematic review. Results of six studies with altogether twelve RE intervention groups could be pooled for meta-analysis of the BCRL. A significant reduction of BCRL after RE was seen in BIS values (95% CI − 1.10 − 2.19, − 0.01 L-Dex score). Furthermore, strength results of six studies could be pooled and meta-analysis showed significant improvements of muscular strength in the upper and lower extremities (95% CI 8.96 3.42, 14.51 kg and 95% CI 23.42 11.95, 34.88 kg, respectively).
Conclusion
RE does not have a systematic negative effect on BCRL and, on the contrary, potentially decreases it.
Relative enhancement (RE) in gadoxetate disodium (Gd-EOB-DTPA)-enhanced MRI is a reliable, non-invasive method for the evaluation and differentiation between simple steatosis and non-alcoholic ...steatohepatitis in adults. This study evaluated the diagnostic accuracy of RE in Gd-EOB-DTPA-enhanced liver MRI and hepatic fat fraction (HFF) in unenhanced liver MRI and ultrasound (US) for non-alcoholic fatty liver disease (NAFLD) screening in pediatric obesity. Seventy-four liver US and MRIs from 68 pediatric patients (13.07 ± 2.95 years) with obesity (BMI > BMI-for-age + 2SD) were reviewed with regard to imaging biomarkers (liver size, volume, echogenicity, HFF, and RE in Gd-EOB-DTPA-enhanced MRIs, and spleen size), blood biomarkers, and BMI. The agreement between the steatosis grade, according to HFF in MRI and the echogenicity in US, was moderate. Alanine aminotransferase correlated better with the imaging biomarkers in MRI than with those in US. BMI correlated better with liver size and volume on MRI than in US. In patients with RE < 1, blood biomarkers correlated better with RE than those in the whole sample, with a significant association between gamma-glutamyltransferase and RE (
= 0.033). In conclusion, the relative enhancement and hepatic fat fraction can be considered as non-invasive tools for the screening and follow-up of NAFLD in pediatric obesity, superior to echogenicity on ultrasound.
Although distributional inequality and concentration are important statistical concepts in many research fields (including economics, political and social science, information theory, and biology and ...ecology), they rarely are considered in psychological science. This practical primer familiarizes with the concepts of statistical inequality and concentration and presents an overview of more than a dozen useful, popular measures of inequality (including the Gini, Hoover, Rosenbluth, Herfindahl-Hirschman, Simpson, Shannon, generalized entropy, and Atkinson indices, and tail ratios). Additionally, an interactive web application (R Shiny) for calculating and visualizing these measures, with downloadable output, is described. This companion Shiny app provides brief introductory vignettes to this suite of measures, along with easy-to-understand user guidance. The Shiny app can readily be used as an intuitively accessible, interactive learning and demonstration environment for teaching and exploring these methods. We provide various examples for the application of measures of inequality and concentration in psychological science and discuss venues for further development.
During the early SARS-CoV-2 pandemic, all healthcare workers had specific and essential functions. However, environmental services (e.g., cleaning staff) and allied health professionals (e.g., ...physiotherapists) are often less recognised inpatient care. The aim of our study was to evaluate SARS-CoV-2-infection rates and describe risk factors relevant to workplace transmission and occupational safety amongst healthcare workers in COVID-19 hospitals before the introduction of SARS-CoV-2-specific vaccines.
This cross-sectional study (from May 2020 to March 2021, standardised WHO early-investigation protocol) is evaluating workplace or health-related data, COVID-19-patient proximity, personal protective equipment (PPE) use, and adherence to infection prevention and control (IPC) measures, anti-SARS-CoV-2-antibody status, and transmission pathways.
Out of n = 221 HCW (n = 189 cleaning/service staff; n = 32 allied health professionals), n = 17 (7.7 %) were seropositive. While even SARS-CoV-2-naïve HCW reported SARS-CoV-2-related symptoms, airway symptoms, loss of smell or taste, and appetite were the most specific for a SARS-CoV-2-infection. Adherence to IPC (98.6 %) and recommended PPE use (98.2 %) were high and not associated with seropositivity. In 70.6 %, transmission occurred in private settings; in 23.5 %, at the workplace (by interaction with SARS-CoV-2-positive colleagues 17.6 % or patient contact 5.9 %), or remained unclear (one case).
Infection rates were higher in all assessed ‘less visible’ healthcare-worker groups compared to the general population. Our data indicates that, while IPC measures and PPE may have contributed to the prevention of patient-to-healthcare-worker transmissions, infections were commonly acquired outside of work and transmitted between healthcare workers within the hospital. This finding emphasises the importance of ongoing education on transmission prevention and regular infection screenings at work.
Meta-analyses suggest that mindfulness interventions have positive effects on mental health. Yet, how mindfulness interventions exert their effects is still largely unknown. Self-reported mindfulness ...may partially mediate the association between mindfulness interventions and change in self-reported mental health. We present the results of a novel application of three-level meta-analysis on the pre-post intervention data of 146 RCTs of mindfulness interventions (total N = 10,979), probing the efficacy of a broad range of mindfulness interventions and meditation training against active, treatment-as-usual (TAU), and wait-list control groups. We found that self-reported mindfulness not only increased in mindfulness interventions (d = 0.54, 95% CI 0.47, 0.61), but also in active (nonmindfulness) controls (d = 0.27 0.18, 0.36) and wait-list controls (d = 0.10 0.04, 0.17; but not TAU controls: d = 0.04 −0.03, 0.12). In addition, change in mindfulness accounted for change in self-reported mental health (mindfulness interventions: d = 0.65 0.57, 0.73; active controls: d = 0.49 0.36, 0.62; TAU controls: d = 0.20 0.12, 0.29; wait-list controls: d = 0.22 0.14, 0.30) in all treatment and control groups alike. Thus, self-reported mindfulness apparently is no unique mediator of mindfulness interventions. It may either be more universal, merely a correlate of self-reported mental health, or both. Research should focus on the common denominator of mindfulness interventions and clinically relevant constructs with which self-reported mindfulness shares some of its characteristics. Limitations pertain to the indirect evidence of the three-level meta-analytic approach, the self-report nature of the data, and small-study effects, which suggest the presence of publication bias. The risk of bias may have led to the overestimation of effects and results could further be subjected to effects of shared method variance.
Public Significance Statement
This meta-analysis suggests that increases in self-reported mindfulness may explain the treatment efficacy of various mindfulness-based interventions, but also of nonmindfulness-based controls. Self-reported mindfulness thus may be no unique mediator of the effects of mindfulness interventions. The current evidence leaves open whether self-reported mindfulness might be a universal mediator of treatment effects, merely reflects changes of self-reported mental health in general, or both.
Acute kidney injury (AKI) is a serious complication in postoperative ICU patients. The incidence of AKI varies substantially based on the type of surgery and definition used. This study focuses on ...the incidence of AKI in postoperative ICU patients using full KDIGO criteria and related outcomes regarding to different types of surgery.
Retrospective cohort study.
Tertiary level university hospital, eight anaesthesiological/surgical ICUs, between 2016 and 2018.
6261 adult patients.
Primary outcome was 28-day all-cause mortality in different stages of AKI according to complete KDIGO criteria.
We found 3497 (55.9%) postoperative ICU patients with AKI. The severity distribution of AKI stage 1 to 3 was 19.7%, 28.4% and 7.8%, respectively, and 235 (4%) patients received RRT. The 28-day mortality was 3% (n = 205). Increasing AKI severity was associated with increased 28-day mortality when adjusted for other variables (AKI 2°: OR 2.81; 95% CI 1.55 to 5.24; p < 0.001 and AKI 3°: OR 11.37.; 95% CI 5.91 to 22.55; p < 0.001). Besides AKI stages 2 and 3, age (OR 1.02; 95% CI 1.01 to 1.04, p < 0.001), NYHA IV (OR 2.23; 95% CI 1.03 to 4.43, p = 0.042), need for surgical reintervention within 48 h (OR 2.92; 95% CI 1.76 to 4.72, p = 0.001), urgent surgery (OR 1.78; 95% CI 1.15 to 2.71, p = 0.01), emergency surgery (OR 2.63; 95% CI 1.58 to 4.31, p = 0.001), vascular surgery (OR 2.01; 95% CI 1.06 to 3.98, p = 0.033), and orthopedic and trauma surgery (OR 3.79; 95% CI 1.98 to 7.09, p < 0.001) versus cardiac surgery was significantly associated with increased risk for 28-days mortality in multivariate analysis.
AKI based on full KDIGO criteria is very common in postoperative ICU patients and it is associated with stepwise increase in 28-days mortality.
•Incidence & outcome of AKI classified by creatinine (SCr) and urine output (UO) criteria are unknown in surgical ICU patients•AKI occurred in nearly 56% of patients within the first week after ICU admission and is associated increased mortality.•The assessment of AKI based on SCr alone failed to identify AKI in many ICU patients.•The assessment of AKI based on both criteria, SCr and UO, increased the AKI incidence by 35%.•Adding the UO criteria unveiled a much higher number of patients with AKI in postoperative ICU patients.
To evaluate the quantitative impact of drusen and hyperreflective foci (HRF) volumes on mesopic retinal sensitivity in non-exudative age-related macular degeneration (AMD).
In a standardized ...follow-up scheme of every three months, retinal sensitivity of patients with early or intermediate AMD was assessed by microperimetry using a custom pattern of 45 stimuli (Nidek MP-3, Gamagori, Japan). Eyes were consecutively scanned using Spectralis SD-OCT (20° × 20°, 1024 × 97 × 496). Fundus photographs obtained by the MP-3 allowed to map the stimuli locations onto the corresponding OCT scans. The volume and mean thickness of drusen and HRF within a circle of 240 µm centred at each stimulus point was determined using automated AI-based image segmentation algorithms.
8055 individual stimuli from 179 visits from 51 eyes of 35 consecutive patients were matched with the respective OCT images in a point-to-point manner. The patients mean age was 76.85 ± 6.6 years. Mean retinal sensitivity at baseline was 25.7 dB. 73.47% of all MP-spots covered drusen area and 2.02% of MP-spots covered HRF. A negative association between retinal sensitivity and the volume of underlying drusen (p < 0.001, Estimate -0.991 db/µm
) and HRF volume (p = 0.002, Estimate -5.230 db/µm
) was found. During observation time, no eye showed conversion to advanced AMD.
A direct correlation between drusen and lower sensitivity of the overlying photoreceptors can be observed. For HRF, a small but significant correlation was shown, which is compromised by their small size. Biomarker quantification using AI-methods allows to determine the impact of sub-clinical features in the progression of AMD.
Background & Aims
Experimental evidence indicates that systemic inflammation (SI) promotes liver fibrogenesis. This study investigated the potential link between SI and fibrogenesis in patients with ...advanced chronic liver disease (ACLD).
Methods
Serum biomarkers of SI (CRP, IL‐6, procalcitonin PCT) and extracellular matrix (ECM) turnover (i.e., fibrogenesis/fibrolysis) were analysed in 215 prospectively recruited patients with ACLD (hepatic venous pressure gradient HVPG ≥6 mm Hg) undergoing hepatic vein catheterization. Patients with non‐elective hospitalization or bacterial infection were excluded. Histological alpha‐smooth muscle actin (α‐SMA) area was quantified on full biopsy scans by automated morphometric quantification in a subset of 34 patients who underwent concomitant transjugular liver biopsy.
Results
Histological α‐SMA proportionate area correlated with enhanced liver fibrosis (ELF) score (Spearman's ρ = 0.660, p < .001), markers of collagen formation (PRO‐C3, ρ = 0.717, p < .001; PRO‐C6, ρ = 0.526, p = .002) and tissue inhibitor of metalloproteinases‐1 (TIMP1; ρ = 0.547, p < .001), indicating that these blood biomarkers are capable of reflecting the dynamic process of ECM turnover. CRP, IL‐6 and PCT levels correlated with ELF, biomarkers of collagen synthesis/degradation and TIMP1, both in compensated and decompensated patients. Multivariate linear regression models (adjusted for HVPG) confirmed that CRP, IL‐6 and PCT were independently linked to markers of liver fibrogenesis and ECM turnover.
Conclusion
Systemic inflammation is linked to both liver fibrogenesis and ECM turnover in ACLD and this association is not confounded by the severity of liver disease, as evaluated by HVPG. Our study confirms experimental data on the detrimental impact of SI on ECM deposition and fibrosis progression in a thoroughly characterized cohort of patients with ACLD.
The effects of cytotoxic chemotherapy on the expression of programmed cell death 1 (PD-1) and its ligand (PD-L1) in cancer cells and peritumoral cells are unclear. The aim of this study was to ...investigate the impact of neoadjuvant chemotherapy on PD-1 and PD-L1 expression in adenocarcinomas of the gastroesophageal junction.
PD-1 and PD-L1 expression in cancer cells and tumor-infiltrating lymphocytes in paired diagnostic biopsies and surgical specimens from patients with pretreated and curatively resected adenocarcinomas of the gastroesophageal junction were evaluated by immunohistochemistry.
Paired tumor samples were available from 40 patients. PD-1 expression in cancer cells (p < 0.001; Exact Symmetry Test) and tumor-infiltrating lymphocytes (p < 0.001; Exact Symmetry Test) increased significantly after neoadjuvant therapy. Furthermore, we observed a significant decrease in PD-L1 expression in cancer cells (p = 0.003) after neoadjuvant therapy was observed.
In this study we could show that tumor-cell expression of PD-1 and PD-L1 was significantly altered in patients with adenocarcinomas of the gastroesophageal junction after receiving neoadjuvant chemotherapy. Based on these observations, patients might profit from the combined use of cytotoxic chemotherapy and the blockade of the PD-1 axis.
•The introduction of immunotherapy represents a paradigm shift in treating cancer.•A number of studies described synergism between cytotoxic chemotherapy and PD-1/PD-L1 immunotherapy.•Our findings suggest that combining cytotoxic chemotherapy with checkpoint inhibitors represents an beneficial option for AEG patients.
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