Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health‐related quality ...of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate‐to‐high intensity combined resistance‐endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6‐month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5‐multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate‐to‐high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273–1281 2017 AASLD.
BACKGROUND.Although some studies have reported significant improvements in physical function and strength after training programs on liver transplant (LT) recipients, there is a lack of knowledge on ...how it affects in static and dynamic balance, being an important part of these participants’ tasks development. The aim of the study was to determine the effects of a 6-month multicomponent circuit training program on static and dynamic balance in LT participants.
METHODS.Fifty-four participants were randomized at 6 months after LT into 2 groupsexercise (EXER) group and control (CONTROL) group, with repeat testing at 6 (baseline) and 12 months after LT. The intervention consisted of a multicomponent training, including balance, strength, endurance, and flexibility training, with exercises arranged in a circuit setup and a moderate intensity with high perceived exertion. Training sessions were performed in the hospital facilities with qualified trainers. To determine differences over time between EXER and CONTROL, mixed-regression linear models with subject variable as random factor and variables of treatment duration, type, and interaction as predictors were used.
RESULTS.The EXER group showed significant differences (P < 0.05) compared with CONTROL in all variables of static and dynamic balance, hip strength (49% versus 13%), agility (−16% versus −1%), and flexibility (78% versus −26%). Adherence to the intervention was 94%, and 80% of the participants continued voluntarily training after the 6 months.
CONCLUSIONS.This study demonstrated that a multicomponent circuit training program at a moderate intensity with high perceived exertion could reduce the probability of injuries because it improves balance on LT recipients.
OBJECTIVE:To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery.
BACKGROUND:EPI is a common complication after pancreatic ...surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients.
METHODS:Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement.
RESULTS:These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were providedone (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement.
CONCLUSIONS:EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.
Review of the treatment of liver hydatid cysts Gomez I Gavara, Concepción; López-Andújar, Rafael; Belda Ibáñez, Tatiana ...
World journal of gastroenterology,
01/2015, Letnik:
21, Številka:
1
Journal Article
Odprti dostop
A review was carried out in Medline,LILACS and the Cochrane Library.Our database search strategy included the following terms: "hydatid ...cyst","liver","management","meta-analysis" and "randomized controlled trial".No language limits were used in the literature search.The latest electronic search date was the 7th of January 2014.Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis.Information from editorials,letters to publishers,low quality review articles and studies done on animals were excluded from analysis.Additionally,well-structured abstracts from relevant articles were selected and accepted for analysis.Standardized forms were designed for data extraction; two investigators entered the data on patient demographics,methodology,recurrence of HC,mean cyst size and number of cysts per group.Four hundred and fourteen articles were identified using the previously described search strategy.After applying the inclusion and exclusion criteria detailed above,57 articles were selected for final analysis: one meta-analysis,9 randomized clinical trials,5 non-randomized comparative prospective studies,7 non-comparative prospective studies,and 34 retrospective studies(12 comparative and 22 noncomparative).Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts.More studies in the literature support the effectiveness of radical treatment compared with conservative treatment.Conservative surgery with omentoplasty is effective in preventing postoperative complications.A laparoscopic approach is safe in some situations.Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver.Radical surgery with preand post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.
Highlights • This study shows a high percentage of patients with alterations in carbohydrate metabolism before liver transplant that decreases significantly after liver transplant. • Patients showed ...improvement to insulin sensitivity. • Analysis of diabetes risk factors before liver transplant shows that BMI and the degree of liver cirrhosis according to the MELD score, are the key risk factors. • In our study, none of the studied immunosuppressants has shown to be a major diabetes risk in patients with liver graft.
Liver transplantation is a treatment that significantly improves the patients' quality of life. However, we should be more ambitious and seek an improvement in their fitness through training ...protocols allowing them to fully return to daily activities. English and Spanish-language articles on PubMed and the Cochrane Library were searched untill 2014. Articles were reviewed by 2 of the authors to determine if they were suitable for inclusion. It is shown a compilation of studies that included patients who have participated in aerobic, strength, or both combined training programs, without implying a risk for the graft function. There is a lack of studies with high scientific evidence that stablish a proper exercise program methodology, supervised by specialists in physical activity and sports.
Purpose
Liver metastases are the most common malignant solid liver lesions, approximately 40% of which stem from colorectal tumors. Liver resection is currently the only curative treatment for ...colorectal cancer liver metastases (CRLM). However, there is a lack of consensus criteria to assess the results of this treatment. In order to evaluate the quality of surgical outcomes, it is necessary to identify quality indicators (QIs) and their corresponding quality standards (QS). We propose a simple method to determine QI and QS in CRLM surgery (CRLMS) and establish acceptable quality limits (AQL) for each QI.
Material and methods
A systematic review of CRLMS results published from 2006 to 2016. Clinical guidelines, consensus conferences, and publications related to the CRLMS were reviewed to identify and select QIs. Once selected, a new review of the papers including the results of at least one of the QIs was performed. Statistical process control (SPC) method was applied to calculate the QS and AQL of each QI. The limits of variability were established from mean and confidence intervals at 95% and 99.8%.
Results
The most relevant QIs and its AQLs were postoperative mortality (2%, < 4.5%), overall postoperative morbidity (33%, < 41%), liver failure (5%, < 8%), postoperative hemorrhage (1%, < 3%), biliary fistula (6%, < 10%), reoperation (3%, < 6%), R1 resection margins (18%, < 25%), and overall survival at 12 and 60 months (84%, > 77%; and 34%, > 25%, respectively).
Conclusions
Despite its limitations, the present study constitutes the most extensive scientific evidence to date on QI and AQL in CRLMS and may constitute a reference in future studies.
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