Pubblicazioni recenti - cardiorespiratory
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Cardiometabolic and immune response to exercise training in patients with metabolic syndrome: retrospective analysis of two randomized clinical trials.
Front Cardiovasc Med2024 ;11():1329633. doi: 10.3389/fcvm.2024.1329633.
Lechner Katharina, Kia Sylvia, von Korn Pia, Dinges Sophia M, Mueller Stephan, Tjønna Arnt-Erik, Wisløff Ulrik, Van Craenenbroeck Emeline M, Pieske Burkert, Adams Volker, Pressler Axel, Landmesser Ulf, Halle Martin, Kränkel Nicolle,
Abstract
BACKGROUND:
Metabolic syndrome (MetS) is defined by the presence of central obesity plus ?two metabolic/cardiovascular risk factors (RF), with inflammation being a major disease-driving mechanism. Structured endurance exercise training (ET) may positively affect these traits, as well as cardiorespiratory fitness (V?Opeak).
AIMS:
We explore individual ET-mediated improvements of MetS-associated RF in relation to improvements in V?Opeak and inflammatory profile.
METHODS:
MetS patients from two randomized controlled trials, ExMET (?=?24) and OptimEx (?=?34), had performed 4- or 3-months supervised ET programs according to the respective trial protocol. V?Opeak, MetS-defining RFs (both RCTs), broad blood leukocyte profile, cytokines and plasma proteins (ExMET only) were assessed at baseline and follow-up. Intra-individual changes in RFs were analysed for both trials separately using non-parametric approaches. Associations between changes in each RF over the exercise period (-fold of baseline values) were correlated using a non-parametrical approach (Spearman). RF clustering was explored by uniform manifold approximation and projection (UMAP) and changes in RF depending on other RF or exercise parameters were explored by recursive partitioning.
RESULTS:
Four months of ET reduced circulating leukocyte counts (63.5% of baseline, ?=?8.0e-6), especially effector subtypes. ET response of MetS-associated RFs differed depending on patients' individual RF constellation, but was not associated with individual change in V?Opeak. Blood pressure lowering depended on cumulative exercise duration (ExMET: ?102?min per week; OptimEx-MetS: ?38?min per session) and baseline triglyceride levels (ExMET:
CONCLUSIONS:
ET significantly lowered effector leukocyte blood counts. The improvement of MetS-associated cardiovascular RFs depended on individual basal RF profile and exercise duration but was not associated with exercise-mediated increase in V?Opeak. Neuropilin-1 may be linked to exercise-mediated triglyceride lowering.
© 2024 Lechner, Kia, von Korn, Dinges, Mueller, Tjønna, Wisløff, Van Craenenbroeck, Pieske, Adams, Pressler, Landmesser, Halle and Kränkel.
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Burden of obstructive sleep apnea in patients with lung cancer and its effect on performance status.
J Sleep Res2024 Apr;():e14212. doi: 10.1111/jsr.14212.
Zidan Mohamed H, Shaarawy Hany M, Gharraf Heba S, Helal Suzan F, Hassan Maged, Rizk Rana,
Abstract
The association between lung cancer and obstructive sleep apnea has remained a matter of debate for years. Obstructive sleep apnea is thought to increase the incidence of lung cancer due to intermittent hypoxaemia and sleep fragmentation. The aim of this study is to assess the prevalence of obstructive sleep apnea in patients with lung cancer and its effect on those patients' performance status. This is a prevalence study that was conducted at Chest Diseases Department, Alexandria Main University Hospitals. We enrolled 153 patients with lung cancer. All patients underwent cardiorespiratory monitoring using a home sleep-testing device. Performance status was assessed using Karnofsky performance status scale. The study included 120 (78.4%) males and 33 (21.6%) females newly diagnosed with lung cancer. The mean age was 59.98?±?11.11?years. Obstructive sleep apnea (apnea-hypopnea index ??5) was present in 134 (87.6%) patients. Eighty-five (63.4%) patients had mild obstructive sleep apnea, 39 (29.1%) patients had moderate obstructive sleep apnea, and 10 (7.46%) patients had severe obstructive sleep apnea. Prolonged nocturnal oxygen desaturation as demonstrated by time of oxygen saturation spent below 90% (T90%) during total sleep time?>?30% was present in 25 (16.3%) patients. There was a significant difference in the median value of Karnofsky performance status scale between patients with lung cancer and associated obstructive sleep apnea and those without obstructive sleep apnea. In conclusion, obstructive sleep apnea is highly prevalent among patients with lung cancer. Performance status is worse among patients with lung cancer in the presence of obstructive sleep apnea. Screening patients with lung cancer for obstructive sleep apnea is important regardless of the presence of classical symptoms of obstructive sleep apnea.
© 2024 European Sleep Research Society.
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Cross-sectional interactive associations of physical activity and sedentary behaviour with physical capacity across adulthood.
J Cachexia Sarcopenia Muscle2024 Apr;():. doi: 10.1002/jcsm.13457.
Raffin Jérémy, Rolland Yves, Aubertin-Leheudre Mylène, Aragoni da Silva Jaqueline, Guyonnet Sophie, Pillard Fabien, Vellas Bruno, de Souto Barreto Philipe, ,
Abstract
BACKGROUND:
The way physical activity (PA) and sedentary behaviour (SB) independently and interactively modify the age-related decline in physical capacity remains poorly understood. This cross-sectional study investigated the independent and interactive associations of PA and SB with physical function and performance throughout the adult life course.
METHODS:
Data from 499 community-dwelling adults (63% female) aged 20-92 years, involved in the INSPIRE Human Translational Cohort, were used in this cross-sectional study. Daily time spent on moderate-to-vigorous PA (MVPA, min/day) and SB (h/day) was measured with activPAL triaxial accelerometers. Physical function and performance were assessed through the measurement of the 4-m usual gait speed (m/s), handgrip strength (kg), lower-limb strength (isokinetic knee extension torque, N·m), estimated lower-limb power (five-time chair-rise test performance, s) and cardiorespiratory fitness (V?Omax, mL/kg/min). Confounder-adjusted multiple linear and curvilinear regressions were performed to investigate how MVPA, SB and their interactions were associated with the physical outcomes (all square root-transformed except gait speed) throughout the adulthood spectrum.
RESULTS:
Interaction analyses revealed that the combination of higher levels of MVPA with lower levels of SB favourably reshaped the negative relationship between handgrip strength and age (age × SB × MVPA: B = -7E-08, SE = 3E-08, P
CONCLUSIONS:
This cross-sectional study demonstrated that reduced sedentary time and increased activity duration were independently and synergistically associated with an attenuated age-related loss in physical capacity. These findings need to be confirmed with longitudinal data but encourage both adopting an active lifestyle and reducing sedentary time as preventive measures against physical aging.
© 2024 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.
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Molecular Transducers of Physical Activity Consortium (MoTrPAC): Human Studies Design and Protocol.
J Appl Physiol (1985)2024 Apr;():. doi: 10.1152/japplphysiol.00102.2024.
Jakicic John M, Study Group MoTrPAC,
Abstract
Physical activity, including structured exercise, is associated with favorable health-related chronic disease outcomes. While there is evidence of various molecular pathways that affect these responses, a comprehensive molecular map of these molecular responses to exercise has not been developed. The Molecular Transducers of Physical Activity Consortium (MoTrPAC) is a multi-center study designed to isolate the effects of structured exercise training on the molecular mechanisms underlying the health benefits of exercise and physical activity. MoTrPAC contains both a pre-clinical and human component. The details of the human studies component of MoTrPAC that include the design and methods are presented here. The human studies contain both an adult and pediatric component. In the adult component, sedentary participants are randomized to 12 weeks of Control, Endurance Exercise Training, or Resistance Exercise Training with outcomes measures completed before and following the 12 weeks. The adult component also includes recruitment of highly active endurance trained or resistance trained participants who only complete measures once. A similar design is used for the pediatric component; however, only endurance exercise is examined. Phenotyping measures include weight, body composition, vital signs, cardiorespiratory fitness, muscular strength, physical activity and diet, and other questionnaires. Participants also complete an acute rest period (adults only) or exercise session (adults, pediatrics) with collection of biospecimens (blood only for pediatrics) to allow for examination of the molecular responses. The design and methods of MoTrPAC may inform other studies. Moreover, MoTrPAC will provide a repository of data that can be used broadly across the scientific community.
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Sleep studies in obese children with obstructive sleep apnea: Pulse oximetry as a diagnostic tool.
J Sleep Res2024 Apr;():e14214. doi: 10.1111/jsr.14214.
Gowai Hani, Ugonna Kelechi,
Abstract
Obstructive sleep apnea is associated with many co-morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with obstructive sleep apnea. Currently, polysomnography is regarded as the gold-standard diagnostic tool for obstructive sleep apnea. The validity of oximetry as a screening and diagnostic tool for obstructive sleep apnea has been the subject of several studies in the literature. There is little published evidence on the use of oximetry in children with obesity. This study assesses whether oximetry is a reliable diagnostic tool for obstructive sleep apnea in obese children. We reviewed the medical records of obese children with a suspected diagnosis of obstructive sleep apnea who underwent oximetry and cardiorespiratory polygraphy or full polysomnography at Sheffield Children's Hospital between January 2010 and March 2022. We compared oximetry results with the apnea-hypopnea index from cardiorespiratory polygraphy or full polysomnography for each patient. A total of 60 patient records were included in the analysis. The sensitivity of oximetry in diagnosing obstructive sleep apnea was 70.9%, with a specificity of 65.5% and a positive predictive value of 68.75%. In the subgroup of subjects with severe obstructive sleep apnea (apnea-hypopnea index?>?10), oximetry had a sensitivity of 87.5%. We concluded that oximetry could be a helpful initial diagnostic tool for obstructive sleep apnea in obese children, but is not entirely reliable. A negative oximetry result in a symptomatic individual should prompt a referral for more detailed investigations, while a positive result can help in treatment decisions without needing a polysomnography.
© 2024 European Sleep Research Society.
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Lean body mass and the cardiorespiratory phenotype: An ethnic-specific relationship in Hans Chinese women and men.
J Cachexia Sarcopenia Muscle2024 Apr;():. doi: 10.1002/jcsm.13464.
Guo Meihan, Diaz-Canestro Candela, Pugliese Nicola Riccardo, Paneni Francesco, Montero David,
Abstract
BACKGROUND:
Lean body mass (LBM) and the functional capacity of cardiovascular (CV) and respiratory systems constitute a female-specific relationship in European-American individuals. Whether this recent finding be extrapolated to the world's largest ethnic group, that is, Hans Chinese (HC, a population characterized by low LBM), is unknown.
METHODS:
Healthy HC adults (n = 144, 50% ?) closely matched by sex, age and physical activity were included. Total and regional (leg, arm and trunk) LBM and body composition were measured via dual-energy X-ray absorptiometry. Cardiac structure, stiffness, central/peripheral haemodynamics and peak O consumption (VO) were assessed via transthoracic echocardiography and pulmonary gas analyses at rest and during exercise up to peak effort. Regression analyses determined the sex-specific relationship of LBM with cardiac and aerobic phenotypes.
RESULTS:
Total and regional LBM were lower and body fat percentage higher in women compared with men (P
CONCLUSIONS:
LBM independently determines internal cardiac dimensions, ventricular mass, distensibility and the capacity to deliver and consume O in HC adults irrespective of sex.
© 2024 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.
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Cost-effectiveness of high-dose influenza vaccination in the Netherlands: Incorporating the impact on both respiratory and cardiovascular hospitalizations.
Vaccine2024 Apr;():. doi: S0264-410X(24)00465-1.
van der Pol Simon, Zeevat Florian, Postma Maarten J, Boersma Cornelis,
Abstract
OBJECTIVES:
We assess the cost-effectiveness of switching from standard-dose quadrivalent influenza vaccination (SD-QIV) to high-dose vaccination (HD-QIV) for Dutch adults aged 60 years and older.
METHODS:
A health-economic model was used to compare the scenario where HD-QIV was implemented compared to the current standard, SD-QIV. This model used a lifetime horizon and assessed the cost-effectiveness from a societal perspective. A recently published meta-analysis was used to incorporate the benefits of HD-QIV, including cardiorespiratory hospitalizations, in analyses considering RCT only or combining RCT and RWE estimates in a scenario analysis.
RESULTS:
Implementing HD-QIV is cost effective at its list price, with an ICER of ?5,400 per QALY gained. The main driver of these results is the prevention of cardiorespiratory hospitalizations. Other public health benefits are the prevention of GP consults and deaths. HD-QIV is highly likely to be cost-effective, reaching a 100% probability of being cost effective at the Dutch willingness-to-pay threshold of ?20,000 per QALY.
CONCLUSIONS:
Implementing HD-QIV for adults aged 60 and over within the existing influenza vaccination campaign is highly cost effective. HD-QIV may support alleviating potential capacity issues in Dutch hospitals in the winter respiratory season.
Copyright © 2024. Published by Elsevier India Pvt Ltd.
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Wearing face masks while climbing stairs influences respiratory physiology.
J Breath Res2024 Apr;():. doi: 10.1088/1752-7163/ad3fde.
Bar-On Ophir, Goldberg Ori, Stafler Patrick, Levine Hagit, Jacobi Eyal, Shmueli Einat, Rothschild Benjamin, Prais Dario, Mei-Zahav Meir,
Abstract
During the COVID-19 pandemic wearing face masks was mandatory. Nowadays, face masks are still encouraged indoors, especially in hospitals. People climbing stairs with masks describe unpredictable dyspnea. Methods: Healthy adults climbed 5 floors with and without a mask. Various cardio-respiratory parameters were measured, including O2-Saturation (O2-Sat) and End-tidal CO2 (EtCO2), at baseline and on the top floor. Subjective indexes, such as Borg's scale, were evaluated. Results: Thirty-two volunteers (16 males), median age 39 years (IQR 32.5-43), median BMI=23.6 (IQR 21.5-25.1), with good fitness levels, participated. Comparing baseline to end-activity, median (IQR): O2-Sat change was -1.0% (-2-0) without mask, versus -3.0% (-4-0) with mask, p=0.003; EtCO2 +7.0 (+3.3-+9) without mask, versus +8.0 (+6 -+12) with mask, p=0.0001. Hypercarbia was seen in 5 (15.6%) participants without mask, median=48mmHg (IQR 47.5-51), and in 11 (34%) participants with mask, median=50mmHg (IQR 47-54), p
© 2024 IOP Publishing Ltd.
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Determinants of exercise adherence in sedentary middle-aged and older adults.
Psychophysiology2024 Apr;():e14591. doi: 10.1111/psyp.14591.
Cabral Danylo F, Fried Peter J, Bigliassi Marcelo, Cahalin Lawrence P, Gomes-Osman Joyce,
Abstract
Regular exercise positively impacts neurocognitive health, particularly in aging individuals. However, low adherence, particularly among older adults, hinders the adoption of exercise routines. While brain plasticity mechanisms largely support the cognitive benefits of exercise, the link between physiological and behavioral factors influencing exercise adherence remains unclear. This study aimed to explore this association in sedentary middle-aged and older adults. Thirty-one participants underwent an evaluation of cortico-motor plasticity using transcranial magnetic stimulation (TMS) to measure changes in motor-evoked potentials following intermittent theta-burst stimulation (iTBS). Health history, cardiorespiratory fitness, and exercise-related behavioral factors were also assessed. The participants engaged in a 2-month supervised aerobic exercise program, attending sessions three times a week for 60?min each, totaling 24 sessions at a moderate-to-vigorous intensity. They were divided into Completers (n?=?19), who attended all sessions, and Dropouts (n?=?12), who withdrew early. Completers exhibited lower smoking rates, exercise barriers, and resting heart rates compared to Dropouts. For Completers, TMS/iTBS cortico-motor plasticity was associated with better exercise adherence (r?=?-.53, corrected p?=?.019). Exploratory hypothesis-generating regression analysis suggested that post-iTBS changes (??=?-7.78, p?=?.013) and self-efficacy (??=?-.51, p?=?.019) may predict exercise adherence (adjusted-R?=?.44). In conclusion, this study highlights the significance of TMS/iTBS cortico-motor plasticity, self-efficacy, and cardiovascular health in exercise adherence. Given the well-established cognitive benefits of exercise, addressing sedentary behavior and enhancing self-efficacy are crucial for promoting adherence and optimizing brain health. Clinicians and researchers should prioritize assessing these variables to improve the effectiveness of exercise programs.
© 2024 Society for Psychophysiological Research.
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Better Cardiorespiratory Fitness Defined as VOmax Increases the Chance of Partial Clinical Remission and Prolongs Remission Duration in People with Newly Diagnosed Type 1 Diabetes.
Clin Med Insights Endocrinol Diabetes2024 ;17():11795514241244872. doi: 11795514241244872.
Floty?ska Justyna, Naskr?t Dariusz, Nied?wiecki Pawe?, Grzelka-Wo?niak Agata, Pype? Aleksandra, Kaczmarek Anita, Cieluch Aleksandra, Zozuli?ska-Zió?kiewicz Dorota, Uruska Aleksandra,
Abstract
INTRODUCTION:
An essential process affecting the course of type 1 diabetes (DM1) is the appearance and duration of clinical remission. One of the most important factors promoting the occurrence of remission is physical activity, due to increased activity of antioxidants, reduces insulin resistance and improves glucose transport. Maximal oxygen capacity (VOmax) is an objective measure of the body's aerobic capacity. To assess VOmax, oxygen uptake should be measured directly during the exercise test. The aim of the study was to evaluate the physical capacity in adults with DM1 and its relationship with the occurrence of partial clinical remission (pCR) during 2?years follow-up.
METHODS:
The pCR was assessed by the following mathematical formula: A1c (%)?+?[4?×?insulin dose (U/kg/d)]. The result ?9 indicates pCR. VOmax was assessed between 6th and 24th month of diabetes duration using an ergospirometer (COSMED K5 System), during an exercise test carried out on a cycloergometer (RAMP incremental exercise test).
RESULTS:
The study group consisted of 32 adults with DM1. People with pCR were proved to have higher VOmax level [36.0 (33.0-41.5) vs 30.9 (26.5-34.4)?ml/min/kg, ?=?.009. Univariate and multivariate regression confirmed a significant association between VOmax and presence of pCR [AOR 1.26 (1.05-1.52), ?=?.015]. Duration of remission was longer among group with higher VOmax results [15 (9-24) vs 9 (0-12)?months, ?=?.043]. The positive relationship was observed between diabetes duration and VOmax (rs?=?0.484, ?=?.005). Multivariate linear regression confirms a significant association between remission duration and VOmax (ml/min/kg) (??=?0.595, ?=?.002).
CONCLUSION:
The higher VOmax, the better chance of partial clinical remission at 2?years of DM1 and longer duration of remission.
© The Author(s) 2024.
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Effect of resistance circuit training on comprehensive health indicators in older adults: a systematic review and meta-analysis.
Sci Rep2024 Apr;14(1):8823. doi: 8823.
Hu Chenxi, Xia Yunpeng, Zeng Dongye, Ye Mingyi, Mei Tao,
Abstract
The aging process leads to the degeneration of body structure and function. The objective of this study is to conduct a systematic review and meta-analysis of the effects of resistance circuit training (RCT) on comprehensive health indicators of older adults. PubMed, Embase, and Web of Science were searched until August 2023. Primary outcomes were body composition, muscle strength, cardiorespiratory endurance, blood pressure, and functional autonomy. Muscle function and exercise intensity subgroups were analyzed. RCT reduces body fat (MD?=?-?5.39 kg, 95% CI?-?10.48 to?-?0.29), BMI (MD?=?-?1.22, 95% CI?-?2.17 to?-?0.26), and body weight (MD?=?-?1.28 kg, 95% CI?-?1.78 to?-?0.78), and increases lean body mass (MD?=?1.42 kg, 95% CI 0.83-2.01) in older adults. It improves upper limb strength (SMD?=?2.09, 95% CI 1.7-2.48), lower limb strength (SMD?=?2.03, 95% CI 1.56-2.51), cardiorespiratory endurance (MD?=?94 m, 95% CI 25.69-162.67), and functional autonomy (MD?=?-?1.35, 95% CI?-?1.73 to?-?0.96). High-intensity RCT benefits BMI and body weight, while low-intensity exercise reduces blood pressure. RCT improves muscle function in push, pull, hip, and knee movements in older adults. RCT improves body composition, muscle strength, cardiorespiratory endurance, blood pressure, and functional autonomy in older adults. High-intensity training is superior for body composition, while moderate to low intensity training is more effective for lowering blood pressure.
© 2024. The Author(s).
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FIT calculator: a multi-risk prediction framework for medical outcomes using cardiorespiratory fitness data.
Sci Rep2024 Apr;14(1):8745. doi: 8745.
Elshawi Radwa, Sakr Sherif, Al-Mallah Mouaz H, Keteyian Steven J, Brawner Clinton A, Ehrman Jonathan K,
Abstract
Accurately predicting patients' risk for specific medical outcomes is paramount for effective healthcare management and personalized medicine. While a substantial body of literature addresses the prediction of diverse medical conditions, existing models predominantly focus on singular outcomes, limiting their scope to one disease at a time. However, clinical reality often entails patients concurrently facing multiple health risks across various medical domains. In response to this gap, our study proposes a novel multi-risk framework adept at simultaneous risk prediction for multiple clinical outcomes, including diabetes, mortality, and hypertension. Leveraging a concise set of features extracted from patients' cardiorespiratory fitness data, our framework minimizes computational complexity while maximizing predictive accuracy. Moreover, we integrate a state-of-the-art instance-based interpretability technique into our framework, providing users with comprehensive explanations for each prediction. These explanations afford medical practitioners invaluable insights into the primary health factors influencing individual predictions, fostering greater trust and utility in the underlying prediction models. Our approach thus stands to significantly enhance healthcare decision-making processes, facilitating more targeted interventions and improving patient outcomes in clinical practice. Our prediction framework utilizes an automated machine learning framework, Auto-Weka, to optimize machine learning models and hyper-parameter configurations for the simultaneous prediction of three medical outcomes: diabetes, mortality, and hypertension. Additionally, we employ a local interpretability technique to elucidate predictions generated by our framework. These explanations manifest visually, highlighting key attributes contributing to each instance's prediction for enhanced interpretability. Using automated machine learning techniques, the models simultaneously predict hypertension, mortality, and diabetes risks, utilizing only nine patient features. They achieved an average AUC of 0.90?±?0.001 on the hypertension dataset, 0.90?±?0.002 on the mortality dataset, and 0.89?±?0.001 on the diabetes dataset through tenfold cross-validation. Additionally, the models demonstrated strong performance with an average AUC of 0.89?±?0.001 on the hypertension dataset, 0.90?±?0.001 on the mortality dataset, and 0.89?±?0.001 on the diabetes dataset using bootstrap evaluation with 1000 resamples.
© 2024. The Author(s).
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Cluster analysis of long COVID symptoms for deciphering a syndrome and its long-term consequence.
Immunol Res2024 Apr;():. doi: 10.1007/s12026-024-09465-w.
Niewolik J, Mikuteit M, Klawitter S, Schröder D, Stölting A, Vahldiek K, Heinemann S, Müller F, Behrens Gmn, Klawonn F, Dopfer-Jablonka A, Steffens S,
Abstract
The long-term symptoms of COVID-19 are the subject of public and scientific discussions. Understanding how those long COVID symptoms co-occur in clusters of syndromes may indicate the pathogenic mechanisms of long COVID. Our study objective was to cluster the different long COVID symptoms. We included persons who had a COVID-19 and assessed long-term symptoms (at least 4 weeks after first symptoms). Hierarchical clustering was applied to the symptoms as well as to the participants based on the Euclidean distance h of the log-values of the answers on symptom severity. The distribution of clusters within our cohort is shown in a heat map.From September 2021 to November 2023, 2371 persons with persisting long COVID symptoms participated in the study. Self-assessed long COVID symptoms were assigned to three symptom clusters. Cluster A unites rheumatological and neurological symptoms, cluster B includes neuro-psychological symptoms together with cardiorespiratory symptoms, and a third cluster C shows an association of general infection signs, dermatological and otology symptoms. A high proportion of the participants (n?=?1424) showed symptoms of all three clusters. Clustering of long COVID symptoms reveals similarities to the symptomatology of already described syndromes such as the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) or rheumatological autoinflammatory diseases. Further research may identify serological parameters or clinical risk factors associated with the shown clusters and might improve our understanding of long COVID as a systemic disease. Furthermore, multimodal treatments can be developed and scaled for symptom clusters and associated impairments.
© 2024. The Author(s).
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Association of preoperative beta-blocker use and cardiac complications after major noncardiac surgery: a prospective cohort study.
Br J Anaesth2024 Apr;():. doi: S0007-0912(24)00105-3.
Glarner Noemi, Puelacher Christian, Gualandro Danielle M, Pargger Mirjam, Huré Gabrielle, Maiorano Silvia, Strebel Ivo, Fried Simona, Bolliger Daniel, Steiner Luzius A, Lampart Andreas, Lurati Buse Giovanna, Mujagic Edin, Lardinois Didier, Kindler Christoph, Guerke Lorenz, Schaeren Stefan, Mueller Andreas, Clauss Martin, Buser Andreas, Hammerer-Lercher Angelika, Mueller Christian, ,
Abstract
INTRODUCTION:
Cardiac complications after major noncardiac surgery are common and associated with high morbidity and mortality. How preoperative use of beta-blockers may impact perioperative cardiac complications remains unclear.
METHODS:
In a multicentre prospective cohort study, preoperative beta-blocker use was ascertained in consecutive patients at elevated cardiovascular risk undergoing major noncardiac surgery. Cardiac complications were prospectively monitored and centrally adjudicated by two independent experts. The primary endpoint was perioperative myocardial infarction or injury attributable to a cardiac cause (cardiac PMI) within the first three postoperative days. The secondary endpoints were major adverse cardiac events (MACE), defined as a composite of myocardial infarction, acute heart failure, life-threatening arrhythmia, and cardiovascular death and all-cause death after 365 days. We used inverse probability of treatment weighting to account for differences between patients receiving beta-blockers and those who did not.
RESULTS:
A total of 3839/10 272 (37.4%) patients (mean age 74 yr; 44.8% female) received beta-blockers before surgery. Patients on beta-blockers were older, and more likely to be male with established cardiorespiratory and chronic kidney disease. Cardiac PMI occurred in 1077 patients, with a weighted odds ratio of 1.03 (95% confidence interval [CI] 0.94-1.12, P=0.55) for patients on beta-blockers. Within 365 days of surgery, 971/10 272 (9.5%) MACE had occurred, with a weighted hazard ratio of 0.99 (95% CI 0.83-1.18, P=0.90) for patients on beta-blockers.
CONCLUSION:
Preoperative use of beta-blockers was not associated with decreased cardiac complications including cardiac perioperative myocardial infarction or injury and major adverse cardiac event. Additionally, preoperative use of beta-blockers was not associated with increased all-cause death within 30 and 365 days.
CLINICAL TRIAL REGISTRATION:
NCT02573532.
Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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WEB OF TRANSFORMATIONS: impact of multicomponent intervention on the relationship between sociodemographic indicators, changes in body composition, cardiorespiratory fitness and biochemical markers in adolescents with overweight and obesity.
Int J Environ Health Res2024 Apr;():1-10. doi: 10.1080/09603123.2024.2341131.
Borfe Leticia, Reuter Cézane Priscila, Bandeira Paulo Felipe Ribeiro, Martins Clarice, Brand Caroline, Gaya Anelise Reis,
Abstract
The study aims to analyze the relationships between changes after multicomponent intervention in sociodemographic indicators, body composition, cardiorespiratory fitness and biochemical markers in overweight/obese adolescents. Quasi-experimental study with 33 overweight/obese adolescents (17 in the intervention group (IG) and 16 in the control group (16)), in which the GI participated in the multicomponent intervention for 24 weeks. Sociodemographic indicators, body composition, cardiorespiratory fitness and biochemical markers were evaluated. Network analysis was performed using JASP software. In GI, the reduction in %BF proved to be the variable with greater connectivity and strength in the network compared to the control network. Changes in %BF were related to changes in ACR, BMI and leptin. It is concluded that the reduction in %BF is the most important variable in network relationships after the intervention, suggesting that the greater the reduction in %BF, the greater the effect on variables such as BMI, ACR and leptina.
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mARC1 in MASLD: Modulation of lipid accumulation in human hepatocytes and adipocytes.
Hepatol Commun2024 May;8(5):. doi: e0365.
Jones Amanda K, Bajrami Besnik, Campbell Morgan K, Erzurumluoglu Abdullah Mesut, Guo Qiusha, Chen Hongxing, Zhang Xiaomei, Zeveleva Svetlana, Kvaskoff David, Brunner Andreas-David, Muller Stefanie, Gathey Vasudha, Dave Rajvee M, Tanner James W, Rixen Sophia, Struwe Michel A, Phoenix Kathryn, Klumph Kaitlyn J, Robinson Heather, Veyel Daniel, Muller Annkatrin, Noyvert Boris, Bartholdy Boris Alexander, Steixner-Kumar Agnes A, Stutzki Jan, Drichel Dmitriy, Omland Steffen, Sheehan Ryan, Hill Jon, Bretschneider Tom, Gottschling Dirk, Scheidig Axel J, Clement Bernd, Giera Martin, Ding Zhihao, Broadwater John, Warren Curtis R,
Abstract
BACKGROUND:
Mutations in the gene MTARC1 (mitochondrial amidoxime-reducing component 1) protect carriers from metabolic dysfunction-associated steatohepatitis (MASH) and cirrhosis. MTARC1 encodes the mARC1 enzyme, which is localized to the mitochondria and has no known MASH-relevant molecular function. Our studies aimed to expand on the published human genetic mARC1 data and to observe the molecular effects of mARC1 modulation in preclinical MASH models.
METHODS AND RESULTS:
We identified a novel human structural variant deletion in MTARC1, which is associated with various biomarkers of liver health, including alanine aminotransferase levels. Phenome-wide Mendelian Randomization analyses additionally identified novel putatively causal associations between MTARC1 expression, and esophageal varices and cardiorespiratory traits. We observed that protective MTARC1 variants decreased protein accumulation in in vitro overexpression systems and used genetic tools to study mARC1 depletion in relevant human and mouse systems. Hepatocyte mARC1 knockdown in murine MASH models reduced body weight, liver steatosis, oxidative stress, cell death, and fibrogenesis markers. mARC1 siRNA treatment and overexpression modulated lipid accumulation and cell death consistently in primary human hepatocytes, hepatocyte cell lines, and primary human adipocytes. mARC1 depletion affected the accumulation of distinct lipid species and the expression of inflammatory and mitochondrial pathway genes/proteins in both in vitro and in vivo models.
CONCLUSIONS:
Depleting hepatocyte mARC1 improved metabolic dysfunction-associated steatotic liver disease-related outcomes. Given the functional role of mARC1 in human adipocyte lipid accumulation, systemic targeting of mARC1 should be considered when designing mARC1 therapies. Our data point to plasma lipid biomarkers predictive of mARC1 abundance, such as Ceramide 22:1. We propose future areas of study to describe the precise molecular function of mARC1, including lipid trafficking and subcellular location within or around the mitochondria and endoplasmic reticulum.
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.
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Oral health and physical performance in Asian military males: The cardiorespiratory fitness and health in armed forces.
J Dent Sci2024 Apr;19(2):998-1003. doi: 10.1016/j.jds.2023.07.013.
Tsai Kun-Zhe, Liu Pang-Yen, Huang Wei-Chun, Chu Chen-Chih, Sui Xuemei, Lavie Carl J, Lin Gen-Min,
Abstract
BACKGROUND/PURPOSE:
It is unclear about whether the oral health has impact on physical performance. Therefore, this study aimed to examine the association between oral health and physical performance in 300 military adults in Taiwan.
MATERIALS AND METHODS:
Oral health was assessed by the presence of periodontitis and dental caries. The status of cardiorespiratory and muscular endurance capacity was respectively assessed by tertiles of time for a 3000-m run and 2-min push-up numbers. Multivariable logistic and linear regression analyses with adjustments for age, smoking, alcohol drinking, blood pressure, anthropometric variables, lipid profile, fasting glucose and physical activity were used to determine the association.
RESULTS:
Participants with periodontitis were more likely to have worse 3000-m running performance classified in the lowest tertile [odds ratio (OR) and 95% confidence interval: 1.94 (1.03, 3.66)]. Participants with any dental caries were more likely to have worse push-ups performance classified in the lowest tertile [OR: 2.50 (1.27, 4.92)]. In linear regression analyses, dental caries numbers were inversely correlated with 2-min push-ups numbers [? = -1.04 (-2.07, -0.01)].
CONCLUSION:
This study suggests that oral health is crucial to maintain physical fitness, and dental caries and periodontitis may affect differently on aerobic and muscular endurance capacities.
© 2023 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.
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Maternal and neonatal effects of epidural levobupivacaine combined with fentanyl or sufentanil for elective cesarean-section in brachycephalic breeds.
Top Companion Anim Med2024 Apr;():100873. doi: 10.1016/j.tcam.2024.100873.
Kanashiro Glaucia P, Lima Camila M S, Nicácio Isabela P G A, Nicácio Gabriel M, Brinholi Rejane B, Cassu Renata N,
Abstract
The aim of this study was to compare the safety and clinical efficacy of epidural levobupivacaine combined with fentanyl or sufentanil for bitches undergoing elective cesarean-section and the impact of these anesthetic protocols on neonatal viability. The anesthetic protocol consisted of intramuscular morphine (0.2 mg/kg), followed by an intravenous bolus of propofol, in a dose sufficient to allowed the puncture of the lumbosacral space. The dogs were randomly allocated to receive 0.5% levobupivacaine plus fentanyl (2.5 µg/kg; LF: n?=?9) or sufentanil (1 µg/kg; LS; n?=?11). Maternal cardiorespiratory parameters were monitored at specific time points during surgery. Intraoperative propofol supplementation was based on the presence of head and/or thoracic limb movements. Neonatal reflex responses and the Apgar score (range 0-10 points) were assessed at 5 and 60 minutes after birth. Puppy mortality rate was recorded until 24 hours after birth. Data were analyzed using two-way ANOVA, Tukey's test, Wilcoxon signed rank test, and Fisher's exact test (P
Copyright © 2024. Published by Elsevier Inc.
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Cardiorespiratory Instability after Percutaneous Patent Ductus Arteriosus Closure: A Multicenter Cohort Study.
J Pediatr2024 Apr;():114052. doi: 10.1016/j.jpeds.2024.114052.
Bischoff Adrianne R, Backes Carl H, Rivera Brian, Jasani Bonny, Patel Foramben, Cheung Erica, Sathanandam Shyam, Philip Ranjit, McNamara Patrick J,
Abstract
OBJECTIVE:
To evaluate post-procedural clinical characteristics of preterm infants undergoing transcatheter patent ductus arteriosus (PDA) closure, including oxygenation/ventilation failure and cardiovascular compromise STUDY DESIGN: Multicenter retrospective cohort study of preterm infants who were ?2 kg at the time of percutaneous PDA closure between August 2018 and July 2021. Indices of cardiorespiratory stability were collected pre-closure, immediately post-closure, and subsequently averaged every 4 hours for the first 24 hours post-procedure. The primary outcome was incidence of post-transcatheter cardiorespiratory syndrome: composite of: (i) hemodynamic instability (defined by systemic hypotension, systemic hypertension, or use of new inotropes/vasopressors in the first 24 hours after catheterization and at least one of the following: (i)ventilation failure or (ii) oxygenation failure.
RESULTS:
A total of 197 patients were included with a median [IQR] age and weight at catheterization of 34 [25, 43] days and 1090 [900, 1367] grams, respectively. The primary composite outcome was reported in 46 (23.3%) patients and subcomponents of oxygenation and/or ventilation failure, systolic hypotension or systolic hypertension were noted in 81 (41.1%), 3 (1.5%) and 86 (43.6%) respectively. Logistic regression models showed weight at catheterization and respiratory severity score pre-closure to be significantly associated with post-transcatheter cardiorespiratory syndrome.
CONCLUSION:
Post-transcatheter cardiorespiratory syndrome is characterized primarily by systemic hypertension and oxygenation failure, with a very low incidence of hypotension and need for inotropes.
Copyright © 2024 Elsevier Inc. All rights reserved.
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Feasibility of a novel exercise program for patients with breast cancer offering different modalities and based on patient preference.
Eur J Oncol Nurs2024 Mar;70():102554. doi: 10.1016/j.ejon.2024.102554.
Borsati Anita, Toniolo Linda, Trestini Ilaria, Tregnago Daniela, Belluomini Lorenzo, Fiorio Elena, Lanza Massimo, Schena Federico, Pilotto Sara, Milella Michele, Avancini Alice,
Abstract
PURPOSE:
Exercise improves quality of life and reduces the side effects of cancer therapies. Nevertheless, attendance to exercise programs remains a challenge for patients. This study explored the feasibility of an exercise program in which women with breast cancer may be allowed to choose among three exercise delivery modalities.
METHODS:
Forty-seven patients with breast cancer (stage I-IV) participated in a 12-week combined aerobic and resistance training program. The exercise modality was chosen by patients according to their preferences and needs among three options: the personal training program, the home-based program, or the group-based program. Exercise prescription was similar between the three modalities. Whereas the primary endpoint was feasibility, assessed through recruitment rate, attendance, adherence, dropout rate, tolerability, and safety, secondary endpoints included health-related skills and quality of life.
RESULTS:
Out of 47 recruited patients, 24 chose the home-based program, 19 the personal training program, and four the group-based program. Six dropouts (13%) were registered, and no severe adverse events were recorded. The median program attendance was 98% for personal training programs, 96% for home-based programs, and 100% for group-based programs, whereas compliance resulted in more than 90% in each modality. At postintervention, a significant increase in cardiorespiratory fitness, lower body flexibility, and body weight was observed. Different quality-of-life domains were improved following the intervention, including physical and social functioning, fatigue, and appetite loss. No significant changes in other parameters were detected.
CONCLUSIONS:
An exercise prescription based on a patient-preferred delivery modality showed high feasibility in women with breast cancer.
Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.
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