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Pubblicazioni recenti - cardiorespiratory
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Sleep-Dependent Directional Interactions of the Central Nervous System-Cardiorespiratory Network.
IEEE Trans Biomed Eng2020 Jul;PP():. doi: 10.1109/TBME.2020.3009950.
Yang Juan, Pan Yu, Wang Tingting, Zhang Xiangmin, Wen Jinfeng, Luo Yuxi,
Abstract
OBJECTIVE:
We investigated the nature of interactions between the central nervous system (CNS) and the cardiorespiratory system during sleep.
METHODS:
Overnight polysomnography recordings were obtained from 33 healthy individuals. The relative spectral powers of five frequency bands, three ECG morphological features and respiratory rate were obtained from six EEG channels, ECG, and oronasal airflow, respectively. The synchronous feature series were interpolated to 1 Hz to retain the high time-resolution required to detect rapid physiological variations. CNS-cardiorespiratory interaction networks were built for each EEG channel and a directionality analysis was conducted using multivariate transfer entropy. Finally, the difference in interaction between Deep, Light, and REM sleep (DS, LS, and REM) was studied.
RESULTS:
Bidirectional interactions existed in central-cardiorespiratory networks, and the dominant direction was from the cardiorespiratory system to the brain during all sleep stages. Sleep stages had evident influence on these interactions, with the strength of information transfer from heart rate and respiration rate to the brain gradually increasing with the sequence of REM, LS, and DS. Furthermore, the occipital lobe appeared to receive the most input from the cardiorespiratory system during LS. Finally, different ECG morphological features were found to be involved with various central-cardiac and cardiac-respiratory interactions.
CONCLUSION:
These findings reveal detailed information regarding CNS-cardiorespiratory interactions during sleep and provide new insights into understanding of sleep control mechanisms.
SIGNIFICANCE:
Our approach may facilitate the investigation of the pathological cardiorespiratory complications of sleep disorders.
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Burden of cause-specific mortality attributable to heat and cold: A multicity time-series study in Jiangsu Province, China.
Environ Int2020 Jul;144():105994. doi: S0160-4120(20)31949-8.
Ma Yiqun, Zhou Lian, Chen Kai,
Abstract
Previous epidemiological studies primarily examined the temperature-related mortality burden of all-cause or cardiovascular diseases (CVD) and respiratory diseases. However, evidence on the heat- and cold-attributable mortality burden from other specific causes is limited. This paper aimed to systematically examine the association of heat and cold with a comprehensive spectrum of plausible temperature-related diseases, and to estimate the mortality burdens attributable to heat and cold. In the time-series study of 11 cities in Jiangsu, China, distributed lag non-linear models were applied to estimate city-specific temperature-mortality associations, and then meta-analysis was conducted to pool the estimates. A total of 1,368,648 cases of death were included in this study. Both extreme heat and cold were associated with increased mortality risks from all-cause, CVD, respiratory diseases, nervous diseases, and external causes. Short-term exposures to heat and cold were associated with excess burden of mortality for several specific diseases, accounting for 16.38% (95% eCI, 7.27-22.31%) for myocardial infarction (MI), 12.41% (95% eCI, 8.81-15.07%) for stroke, 27.97% (95% eCI, 18.42-33.35%) for hypertensive heart disease, 25.18% (95% eCI, 18.42-29.63%) for chronic obstructive pulmonary disease, and 28.46% (95% eCI: 4.93-33.57%) for Alzheimer's and dementia. Diabetes was only associated with extreme heat, with 4.61% (95% eCI, 0.13-7.13%) of diabetes mortality attributable to heat. In total, 11.98% (95% eCI, 10.46-13.08%) of mortality was attributable to heat and cold, with 3.49% (95% eCI, 2.87-4.00%) attributable to heat and 8.48% (95% eCI, 7.31-9.49%) attributable to cold, and about 64% of this overall temperature-related mortality burden was found in 6 aforementioned specific causes and about 10% of mortality burden in external causes. Extreme heat and/or cold are associated with increased risks of mortality from a wide range of causes, including previously identified causes in cardiorespiratory diseases and under-studied causes such as diabetes and Alzheimer's and dementia. Future research is needed to confirm the substantial mortality burden of heat and cold.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Promoting health-related cardiorespiratory fitness in physical education: A systematic review.
PLoS One2020 ;15(8):e0237019. doi: 10.1371/journal.pone.0237019.
Peralta Miguel, Henriques-Neto Duarte, Gouveia Élvio Rúbio, Sardinha Luís B, Marques Adilson,
Abstract
BACKGROUND:
This article aimed to systematically review the contribution of physical education (PE) classes to improve cardiorespiratory fitness (CRF) in children and adolescents; and to define potentially relevant factors for promoting CRF in PE classes.
METHODS:
Studies were identified from searches in ERIC, PubMed, SPORTDiscus, and Web of Science databases. Primary source articles, relating PE classes and CRF, published up to July 2019 in peer-reviewed journals were eligible for inclusion. Specific inclusion criteria were: (a) having cross-sectional or longitudinal and observational or interventional study designs; (b) targeting school-aged children or adolescents; (c) measuring CRF, heart rate or CRF test results as an outcome; (d) having statistical analyses of the CRF, heart rate or CRF test results outcomes reported; (e) focusing on PE classes or PE interventions that did not extended time or frequency of the classes; and (f) published in English, French, Portuguese, or Spanish.
RESULTS:
A total of 24 studies met the inclusion criteria. Overall, 10 studies have found a neutral effect of PE classes in students' CRF, eight studies found that PE indeed contributed to the improvement of CRF and six studies revealed mixed findings, when PE classes where controlled for others variables (e.g. body mass index, intensity). Higher intensity PE classes consistently demonstrated contributions to improving students' CRF.
CONCLUSION:
Review findings suggest that PE classes can contribute to the improvement of students' CRF. Intensity, age and weight status were identified as potentially relevant factors for promoting CRF in PE classes. To improve CRF, higher intensity classes should be provided.
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Interrelationship of physical exercise, perceptual discrimination and academic achievement variables in high school students.
Ann Ig;32(5):528-540. doi: 10.7416/ai.2020.2373.
El Jaziz A, Lotfi S, Ahami A O T,
Abstract
BACKGROUND:
Many studies results suggest how can we improve the academic performance for our kids. The purposes of this study were to examine how physical activity could affect both academic achievement and fluid intelligence in adolescence.
STUDY DESIGN:
We measured the three variables (physical, cognitive, academic) and try to find the correlations between them.
METHODS:
A total of 167 adolescents (mean age = 16.34 years SD = 1.2) from Morocco are participating in this study. The cardiorespiratory fitness was measured with the20 m endurance shuttle-run test. We also assessed the Resistance capacity with 500m sprint test. The academic achievement was assessed by school grades. The fluid intelligence was assessed by using Raven's Standard Progressive Matrices. We examined the correlation between all variables.
RESULTS:
This study indicates that the academic achievement was positively associated with the Fluid Intelligence and also with the Resistance Capacity and not with Cardiorespiratory Fitness (VO2peak).
CONCLUSIONS:
We can conclude that the professionals and researchers in sports and education have to promote physical activity at the school age for a public health purpose.
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The Effects of Concurrent Training Order on Satellite Cell-Related Markers, Body Composition, Muscular and Cardiorespiratory Fitness in Older Men with Sarcopenia.
J Nutr Health Aging2020 ;24(7):796-804. doi: 10.1007/s12603-020-1431-3.
Moghadam B H, Bagheri R, Ashtary-Larky D, Tinsley G M, Eskandari M, Wong A, Moghadam B H, Kreider R B, Baker J S,
Abstract
OBJECTIVES:
Concurrent Training (CT) is described as a combination of resistance training (RT) and endurance training (ET) in a periodized program to maximize all aspects of physical performance. To date, effects of CT order on muscular and cardiorespiratory fitness adaptations are controversial. Owing to the age-related decrement in satellite cells (SC) which are critical for fiber repair, conservation, muscle hypertrophy as well as cardiorespiratory fitness, the present study examined the response of SC related markers to CT order in older sarcopenic men.
PARTICIPANTS:
Thirty older men (age= 64.3 ± 3.5 years) were randomly assigned into one of 3 groups, ET followed by RT (E+R; n=10), RT followed by ET (R+E; n= 10) or a control (C; n=10).
INTERVENTION:
The training protocol consisted of 3 exercise sessions per week for 8 weeks. Blood samples were obtained at baseline and 48 hours after the final training session.
RESULTS:
Weight, skeletal muscle mass, lower and upper body power, maximal oxygen consumption (VO2max), Paired Box 7 (Pax7), and Myogenic factor 5 (Myf5) significantly increased, while were percent body fat significantly decreased following E+R and R+E compared to C. Importantly, the improvement in skeletal muscle mass, lower and upper body power, Myf5 and Pax7 in the E+R was significantly greater than the R+E group. Myogenin (Myog) and Paired Box 3 (Pax3) significantly increased (P < 0.01) in both training groups compared to no changes in C.
CONCLUSION:
An 8-week CT intervention improves SC related markers, body composition and enhances power and VO2max in older sarcopenic participants, regardless of the order of RT and ET. However, performing ET before RT may be more effective at enhancing skeletal muscle mass, Myf5 and Pax7, in addition to both lower and upper body power. While both CT programs produced notable physiological and performance benefits, performing ET before RT during CT may provide the greatest therapeutic benefits for aging individuals.
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Overweight during lactation and its implications for biometric, nutritional and cardiovascular parameters of young and adult male and female rats.
J Nutr Sci2020 ;9():e27. doi: 10.1017/jns.2020.21.
de Araújo Gracielle Amaral, Farias Raysa da Silva, Pedro Samuel de Sousa, Rocha Nazareth N, Brito Fernanda C F, Scaramello Christianne B V,
Abstract
Litter size reduction can induce early overnourishment, being an attractive experimental model to study short- and long-term consequences of childhood obesity. Epidemiological data indicate sex differences regarding cardiometabolic disorders and hypertrophic cardiomyopathy. The present study aimed to describe biometric, nutritional and cardiovascular changes related to neonatal overweight promoted by litter size reduction in young and adult Wistar rats of both sexes. Litter adjustment to eight or four pups/mother (1:1 male-to-female ratio) gave, respectively, control and overweight groups. Body mass, food intake, haemodynamic and echocardiographic parameters and cardiorespiratory capacity were evaluated at postnatal days 30 and 150. Diminished litters were correlated with higher body mass and weight gain (12 %) during lactation, validating the experimental model of neonatal overweight. Soon after weaning male (16 %) and female (25 %) offspring of these litters presented a lower food intake than their respective control, without differences in body mass. Adult males from reduced litters presented higher abdominal circumference (7 %), systolic blood pressure (10 %), interventricular septum thickness (15 %) and relative wall thickness (15 %) compared with their respective control. Rats' performance on the maximal effort ergometer test was not affected by neonatal overweight. Data suggest the occurrence of catch-down growth and hypophagia in male and female rats submitted to neonatal overweight. However, only male rats presented haemodynamic and cardiac structural changes. These findings are crucial to personalised/gender medicine.
© The Author(s) 2020.
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Cardiorespiratory Fitness, Body Mass Index and Insulin Resistance in Healthy Adults.
Am J Med -
Impact of respiratory physical therapy on heart rate autonomic control in children with leukemia.
Support Care Cancer2020 Aug;():. doi: 10.1007/s00520-020-05629-0.
Kirizawa Jociele M, Garner David M, Valenti Vitor E,
Abstract
INTRODUCTION:
Considering that heart rate (HR) autonomic control is impaired in cancer and subsequent respiratory effort may overload the heart, we aimed to evaluate the effect of a respiratory physical therapy session on HR autonomic regulation in children with leukemia so as to confirm its safety.
METHODS:
We selected children with leukemia (n?=?10) and healthy children (n?=?11), which were submitted to a session of respiratory physical therapy. We used Spiron Kids (NCS, Brazil), Children's Voldyne (HUDSON RCI, USA), and Shaker (NCS, Brazil) as respiratory devices. The respiratory exercise protocols were founded on three standardized protocols. HR variability (HRV) was analyzed before, in the first minute and 5 to 10 min after intervention.
RESULTS:
We recognized no change between rest and recovery from intervention in HRV (rMSSD-square root mean square of the differences between adjacent normal R-R intervals)-Control: p?=?0.8111, Leukemia: p?=?0.1197, among groups: p?=?0.6574; SD1-standard deviation from instantaneous beat-to-beat variability-Control: p?=?0.8111, Leukemia: p?=?0.131, among groups: p?=?0.6556; 0V-with no variation (3 equal symbols, for example (2,2,2)-Control: p?=?0.3679, Leukemia: p?=?0.3553, among groups: p?=?0.7421); 2UV-with two variations to the contrary (the three symbols form a peak or a valley, for instance (3,5,3)-Control: p?=?0.3679, Leukemia: p?=?0.2359, among groups: p?=?0.4007). HF-high frequency component, range 0.15 to 0.4 Hz-decreased 0 to 1 min after intervention in the leukemia group (p?=?0.0303) and no change was observed in the control group between rest versus recovery from intervention (p?=?0.9761). No significant change was reported in HF between groups (p?=?0.8700). Two leukemia subjects treated with vincristine presented different HRV responses to the intervention group.
CONCLUSION:
A respiratory physical therapy session did not significantly change autonomic control of HR in children with leukemia. Yet, clinicians should be mindful of subjects undergoing treatment with vincristine.
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Heart, lungs, and muscle interplay in worsening activity-related breathlessness in advanced cardiopulmonary disease.
Curr Opin Support Palliat Care2020 Jul;():. doi: 10.1097/SPC.0000000000000516.
Alberto Neder J, O'Donnell Denis E,
Abstract
PURPOSE OF REVIEW:
Activity-related breathlessness is a key determinant of poor quality of life in patients with advanced cardiorespiratory disease. Accordingly, palliative care has assumed a prominent role in their care. The severity of breathlessness depends on a complex combination of negative cardiopulmonary interactions and increased afferent stimulation from systemic sources. We review recent data exposing the seeds and consequences of these abnormalities in combined heart failure and chronic obstructive pulmonary disease (COPD).
RECENT FINDINGS:
The drive to breathe increases ('excessive breathing') secondary to an enlarged dead space and hypoxemia (largely COPD-related) and heightened afferent stimuli, for example, sympathetic overexcitation, muscle ergorreceptor activation, and anaerobic metabolism (largely heart failure-related). Increased ventilatory drive might not be fully translated into the expected lung-chest wall displacement because of the mechanical derangements brought by COPD ('inappropriate breathing'). The latter abnormalities, in turn, negatively affect the central hemodynamics which are already compromised by heart failure. Physical activity then decreases, worsening muscle atrophy and dysfunction.
SUMMARY:
Beyond the imperative of optimal pharmacological treatment of each disease, strategies to lessen ventilation (e.g., walking aids, oxygen, opiates and anxiolytics, and cardiopulmonary rehabilitation) and improve mechanics (heliox, noninvasive ventilation, and inspiratory muscle training) might mitigate the burden of this devastating symptom in advanced heart failure-COPD.
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Determinants of Cardiorespiratory Fitness After Bariatric Surgery: Insights From a Randomised Controlled Trial of a Supervised Training Program.
Can J Cardiol2020 Mar;():. doi: S0828-282X(20)30305-6.
Auclair Audrey, Harvey Jany, Leclerc Jacinthe, Piché Marie-Eve, O'Connor Kim, Nadreau Éric, Pettigrew Myriam, Haykowsky Mark J, Marceau Simon, Biertho Laurent, Hould Frédéric-Simon, Lebel Stéfane, Biron Simon, Julien François, Bouvet Léonie, Lescelleur Odette, Poirier Paul,
Abstract
BACKGROUND:
Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgery-induced weight loss improves CRF, but the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training program on CRF after bariatric surgery.
METHODS:
Fifty-eight severely obese patients (46.1 ± 6.1 kg/m, 78% women) were randomly assigned to either an exercise group (n = 39) or usual care (n = 19). Exercise training was conducted from the 3rd to the 6th months after surgery. Anthropometric measurements, abdominal and mid-thigh computed tomographic scans, resting echocardiography, and maximal cardiopulmonary exercise testing was performed before bariatric surgery and 3 and 6 months after surgery.
RESULTS:
Weight, fat mass, and fat-free mass were reduced significantly at 3 and 6 months, without any additive impact of exercise training in the exercise group. From 3 to 6 months, peak aerobic power (V?O) increased significantly (P < 0.0001) in both groups but more importantly in the exercise group (exercise group: from 18.6 ± 4.2 to 23.2 ± 5.7 mL/kg/min; control group: from 17.4 ± 2.3 to 19.7 ± 2.4 mL/kg/min; P value, group × time = 0.01). In the exercise group, determinants of absolute V?O (L/min) were peak exercise ventilation, oxygen pulse, and heart rate reserve (r = 0.92; P < 0.0001), whereas determinants of V?O indexed to body mass (mL/kg/min) were peak exercise ventilation and early-to-late filling velocity ratio (r = 0.70; P < 0.0001).
CONCLUSIONS:
A 12-week supervised training program has an additive benefit on cardiorespiratory fitness for patients who undergo bariatric surgery.
Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Associations between physical activity, body composition and physical fitness in the transition from preschool to school.
Scand J Med Sci Sports2020 Aug;():. doi: 10.1111/sms.13784.
Reisberg Kirkke, Riso Eva-Maria, Jürimäe Jaak,
Abstract
The purpose of the study was to assess the longitudinal associations of physical activity (PA) with body composition and physical fitness (PF) at the 12-month follow-up during the transition from kindergarten to school in Estonian children aged 6 to 8 years (n=147). PAand sedentary behaviour (SB) were assessed using the accelerometer. Body composition was measured from triceps and subscapular skinfold thicknesses and PF using PREFIT test battery. SB at the mean age of 6.6 yr had negative relation with upper and lower body strength and motor fitness at the mean age of 7.6 yr in adjusted models. Light PA (LPA) and moderate PA(MPA) at 6.6 yr were positively and SB was negatively associated with fat-free mass index (FFMI) at 7.6 yrafter adjustments for confounders[vigorous PA (VPA), total awake wear time, child's sex, age at measurement]. Substituting 5 min/day of SB at 6.6 yr with 5 min of VPA was related to higher FFMI at 7.6 yr. In adjusted models, VPA at 6.6 yr waspositively associated with cardiorespiratory fitness at 7.6 yr,greaterbaseline VPA ormoderate-to-vigorous PA (MVPA)predicted greater upper body strength a year later and LPA, MPA, VPA, MVPA at 6.6 yrwere positively related to lower body strength at follow-up.In adjusted analysis greater VPA at 6.6 yr was related to better motor fitnessat follow-up. Promoting higher-intensity PA and reducing SB at preschool may have long-term effects on body composition and PF in children at the first grade.
This article is protected by copyright. All rights reserved.
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Defining Death: Lessons From the Case of Jahi McMath.
Pediatrics2020 Aug;146(Suppl 1):S75-S80. doi: 10.1542/peds.2020-0818O.
Truog Robert D,
Abstract
Death is defined biologically as the irreversible loss of the functioning of the organism as a whole, which typically occurs after the loss of cardiorespiratory function. In 1968, a Harvard committee proposed that death could also be defined neurologically as the irreversible loss of brain function. Brain death has been considered to be equivalent to cardiorespiratory arrest on the basis of the belief that the brain is required to maintain functioning of the organism as a whole and that without the brain, cardiorespiratory arrest and biological death are both rapid and certain. Over the past 20 years, however, this equivalence has been shown to be false on the basis of numerous cases of patients correctly diagnosed as brain-dead who nevertheless continued to survive for many years. The issue reached national attention with the case of Jahi McMath, a young woman diagnosed as brain-dead after a surgical accident, who survived for almost 5 years, mostly at home, supported with a ventilator and tube feedings. The fact that brain death is not biological death has many implications, notably including the concern that procurement of organs from brain-dead donors may not comply with the so-called dead donor rule, which requires that vital organs be procured from patients only after they are dead. In this article, I conclude with an analysis of options for moving forward and among them advocate for reframing brain death as a "social construct," with implicit societal acceptance that patients diagnosed as brain-dead may be treated legally and ethically the same as if they were biologically dead.
Copyright © 2020 by the American Academy of Pediatrics.
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Respiratory Failure Secondary to Diaphragmatic Paralysis from Acute Exacerbation of Dermatomyositis.
Am J Med Sci2020 Jul;():. doi: S0002-9629(20)30289-5.
Chong Woon H, Saha Biplab, Jones David M, Beegle Scott,
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory disorder that presents with proximal muscle weakness and typical DM skin changes. DM can involve other organs such as the lung, esophagus, and heart. Diaphragmatic muscle paralysis is an unrecognized clinical presentation of acute DM exacerbation. A 58-year-old man with a history of DM presented to the hospital after sustaining a cardiorespiratory arrest. Before arrest, he had been suffering from progressive dyspnea and muscle weakness. Immunosuppressive therapy of tacrolimus for DM was recently discontinued due to renal toxicity. Bedside ultrasound of the diaphragm while intubated revealed evidence of bilateral diaphragmatic paralysis. After extubation, supine and upright pulmonary function tests (PFT) and sniff test results strengthened the diagnosis of diaphragmatic paralysis. The patient was worked up for an acute DM exacerbation as the likely etiology of the severe diaphragmatic muscle weakness (diaphragmatic paralysis) and ventilatory failure. Skin and muscle biopsy confirmed the diagnosis of active DM. The patient was treated with high dose steroids and mycophenolate mofetil, following which he soon recovered.
Copyright © 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
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Traditional and New Perspectives on Youth Cardiorespiratory Fitness.
Med Sci Sports Exerc2020 Jul;():. doi: 10.1249/MSS.0000000000002418.
Armstrong Neil, Welsman Jo,
Abstract
PURPOSE:
To review traditional and new perspectives in the interpretation of the development of youth cardiorespiratory fitness (CRF).
METHODS:
Analyses of data from, i) the literature which for 80 years has been traditionally based on interpretations of peak oxygen uptake (V?O2) in ratio with body mass (BM) and, ii) recent multilevel allometric models founded on 994 (475 from girls) determinations of 10 to 16-year-olds' peak V?O2 with measures of age, maturity status, and morphological covariates (BM and fat free mass (FFM)), and from 10-13 years, 110 peak V?O2 determinations of maximum cardiovascular covariates (stroke volume, cardiac output, and arteriovenous oxygen difference).
RESULTS:
Application of ratio scaling of physiological variables requires satisfying specific statistical assumptions which are seldom met. In direct conflict with the ratio-scaled data interpretation of CRF, multilevel allometric modelling shows that with BM controlled for, peak V?O2 increases with age but the effect is smaller in girls than boys. Maturity status exerts a positive effect on peak V?O2, in addition to those of age and BM. Changes in maximum cardiovascular covariates contribute to explaining the development of CRF but FFM (as a surrogate for active muscle mass) is the most powerful single influence. With age, maturity status, morphological covariates, and maximum cardiovascular covariates controlled for, there remains an unexplained ~4% to ~9% sex difference in peak V?O2.
CONCLUSIONS:
The traditional interpretation of peak V?O2 in ratio with BM is fallacious and leads to spurious correlations with other health-related variables. Studies of the development of CRF require analyses of sex-specific, concurrent changes in age- and maturation-driven morphological and maximum cardiovascular covariates. Multilevel allometric modelling provides a rigorous, flexible, and sensitive method of data analysis.
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A systematic review of outcomes reported inpediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group.
Paediatr Anaesth2020 Jul;():. doi: 10.1111/pan.13981.
Muhly Wallis T, Taylor Elsa, Razavi Cyrus, Walker Suellen M, Yang Lei, de Graaff Jurgen C, Vutskits Laszlo, Davidson Andrew, Zuo Yunxia, Pérez-Pradilla Carolina, Echeverry Piedad, Torborg Alexandra M, Xu Ting, Rawlinson Ellen, Subramanyam Rajeev, Whyte Simon, Seal Robert, M Meyer Heidi, Yaddanapudi Sandhya, Goobie Susan M, Cravero Joseph P, Keaney Aideen, Graham M Ruth, Ramo Tania, Stricker Paul A, ,
Abstract
The Pediatric Perioperative Outcomes Group (PPOG) is an international collaborative of clinical investigators and clinicians within the subspecialty of pediatric anesthesiology and perioperative care which aims to use COMET (Core Outcomes Measures in Effectiveness Trials) methodology to develop core outcome setsfor infants, children and young people that are tailored to the priorities of the pediatric surgical population.Focusing on four age-dependent patient subpopulations determined a priori for core outcome set development: i) neonates and former preterm infants (up to 60 weeks postmenstrual age); ii) infants (>60 weeks postmenstrual age - <1 year); iii) toddlers and school age children (>1-<13 years); and iv) adolescents (>13-<18 years), we conducted a systematic review of outcomes reported in perioperative studies that include participants within age-dependent pediatric subpopulations. Our review of pediatric perioperative controlled trials published from 2008 to 2018 identified 724 articles reporting 3192 outcome measures. The proportion of published trials and the most frequently reported outcomes varied across pre-determined age groups. Outcomes related to patient comfort, particularly pain and analgesic requirement, were the most frequent domain for infants, children and adolescents. Clinical indicators, particularly cardiorespiratory or medication-related adverse events, were the most common outcomes for neonates and infants < 60 weeks and were the second most frequent domain at all other ages. Neonates and infants <60 weeks of age were significantly under-represented in perioperative trials. Patient-centered outcomes, heath care utilization, and bleeding/transfusion related outcomes were less often reported. In most studies, outcomes were measured in the immediate perioperative period, with the duration often restricted to the post-anesthesia care unit or the first 24 postoperative hours. The outcomes identified with this systematic review will be combined with patient centered outcomes identified through a subsequent stakeholder engagement study to arrive at a core outcome set for each age-specific group.
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Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.
Front Physiol2020 ;11():606. doi: 10.3389/fphys.2020.00606.
Patten Rhiannon K, Boyle Russell A, Moholdt Trine, Kiel Ida, Hopkins William G, Harrison Cheryce L, Stepto Nigel K,
Abstract
Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive and metabolic manifestations. Exercise training has consistently been found to result in improved clinical outcomes in women with PCOS, but shortfalls with exercise prescription are evident. The aim of this systematic review and meta-analysis was to identify exercise intervention characteristics that provide favourable outcomes in women with PCOS. A systematic review of published literature was conducted using EBSCOhost and Ovid Medline up to May 2019. The review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines as per our PROSPERO protocol (CRD42018088367). Randomised controlled trials, non-randomised controlled trials, and uncontrolled trials that evaluated an exercise intervention of at least moderate intensity in women with PCOS were included. Meta-analyses were performed using general linear mixed modelling and Bayesian inferences about effect magnitudes. Thirty-three articles were identified for systematic review of which 19 were meta-analysed. Intervention duration ranged from 6 to 26 weeks. A total number of 777 women were included in the meta-analysis. The meta-analysis found that improvements in health outcomes are more dependent on exercise intensity rather than dose. Fixed effects analysis reported a moderate increase in VO (24.2%; 90% CL, 18.5-30.1), and small reductions in HOMA-IR (-36.2%; 90% CL, -55.3 to -9.0), and waist circumference (-4.2%; 90% CL -6.0 to -2.3) as a result of vigorous intensity exercise. These results are confirmed in the predicted analysis which reported the greatest improvements in VO, BMI, and waist circumference after vigorous intensity exercise alone or when combined with diet, particularly for women with clinically adverse baseline values. Exercise training in the management of PCOS is becoming more common. Results from our analysis support the use of exercise and suggest that vigorous intensity exercise may have the greatest impact on cardiorespiratory fitness, body composition, and insulin resistance. Our results indicate that, a minimum of 120 min of vigorous intensity per week is needed to provide favourable health outcomes for women with PCOS with studies of longer duration required to evaluate outcomes with sustained exercise.
Copyright © 2020 Patten, Boyle, Moholdt, Kiel, Hopkins, Harrison and Stepto.
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Precision-based exercise as a new therapeutic option for children and adolescents with haematological malignancies.
Sci Rep2020 Jul;10(1):12892. doi: 10.1038/s41598-020-69393-1.
Lanfranconi Francesca, Zardo W, Moriggi T, Villa E, Radaelli G, Radaelli S, Paoletti F, Bottes E, Miraglia T, Pollastri L, Vago P, Nichelli F, Jankovic M, Biondi A, Balduzzi A,
Abstract
Children and adolescents with haematological malignancies (PedHM) are characterized by a severe loss of exercise ability during cancer treatment, lasting throughout their lives once healed and impacting their social inclusion prospects. The investigation of the effect of a precision-based exercise program on the connections between systems of the body in PedHM patients is the new frontier in clinical exercise physiology. This study is aimed at evaluating the effects of 11 weeks (3 times weekly) of combined training (cardiorespiratory, resistance, balance and flexibility) on the exercise intolerance in PedHM patients. Two-hundred twenty-six PedHM patients were recruited (47% F). High or medium frequency participation (HAd and MAd) was considered when a participant joined;?>?65% or between 30% and?
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Feasibility and Efficacy of Cardiopulmonary Rehabilitation following COVID-19.
Am J Phys Med Rehabil2020 Jul;():. doi: 10.1097/PHM.0000000000001549.
Hermann Matthias, Pekacka-Egli Anna-Maria, Witassek Fabienne, Baumgaertner Reiner, Schoendorf Sabine, Spielmanns Marc,
Abstract
The COVID-19 pandemic affects a large number of patients with a rapid progression of respiratory failure often requiring hospitalization or intensive care unit treatment in some patients. Survivors of severe COVID-19 suffer from persistent weakness and cardiorespiratory failure. Feasibility and potential benefit of cardiopulmonary rehabilitation (CR) after COVID-19 remains unclear. Therefore, we retrospectively analyzed a cohort of COVID-19 patients in a single center inpatient rehabilitation clinic and describe performance and outcome during CR.Patients were referred from acute care hospitals for rehabilitation after severe COVID-19. The cohort (n=28) was divided in ventilated or not ventilated patients for further analysis. 50% were female, mean age was 66 years and patients stayed in the acute hospital for 19.3±10.7 days before referral for CR. 17 patients (61%) needed previous ICU treatment in the acute care hospital. Risk factors, assessments and questionnaires on admission were comparable in both groups. Significant enhancements were observed in 6-minute walking test and Feeling Thermometer which were independent of previous ventilation status.In conclusion, comprehensive CR following COVID-19 is safe, feasible and effective. Improvements in physical performance and subjective health status were independent of previous ventilation.
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Skin-to-skin care alters regional ventilation in stable neonates.
Arch Dis Child Fetal Neonatal Ed2020 Jul;():. doi: fetalneonatal-2020-319136.
Schinckel Nicholas F, Hickey Leah, Perkins Elizabeth J, Pereira-Fantini Prue M, Koeppenkastrop Sienna, Stafford Isabella, Dowse Georgie, Tingay David G,
Abstract
OBJECTIVE:
Skin-to-skin care (SSC) has proven psychological benefits; however, the physiological effects are less clearly defined. Regional ventilation patterns during SSC have not previously been reported. This study aimed to compare regional ventilation indices and other cardiorespiratory parameters during prone SSC with supine and prone position cot-nursing.
DESIGN:
Prospective observational study.
SETTING:
Single quaternary neonatal intensive care unit in Australia.
PATIENTS:
20 infants spontaneously breathing (n=17) or on non-invasive ventilation (n=3), with mean (SD) gestational age at birth of 33 (5) weeks.
INTERVENTIONS:
Thirty-minute episodes of care in each position: supine cot care, prone SSC and prone cot care preceding a 10?min period of continuous electrical impedance tomography measurements of regional ventilation.
MAIN OUTCOME MEASURES:
In each position, ventral-dorsal and right-left centre of ventilation (CoV), percentage of whole lung ventilation by region and percentage of apparent unventilated lung regions were determined. Heart and respiratory rates, oxygen saturation and axillary temperature were also measured.
RESULTS:
Heart and respiratory rates, oxygen saturation, temperature and right-left lung ventilation did not differ between the three positions (mixed-effects model). Ventilation generally favoured the dorsal lung, but the mean (95%?CI) ventrodorsal CoV was -2.0 (-0.4 to -3.6)% more dorsal during SSC compared with prone. Supine position resulted in 5.0 (1.5 to 5.3)% and 4.5 (3.9 to 5.1)% less apparently unventilated lung regions compared with SSC and prone, respectively.
CONCLUSIONS:
In clinically stable infants, SSC generates a distinct regional ventilation pattern that is independent of prone position and results in greater distribution of ventilation towards the dorsal lung.
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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The Effect of a Novel Low-Volume Aerobic Exercise Intervention on Liver Fat in Type 2 Diabetes: A Randomized Controlled Trial.
Diabetes Care2020 Jul;():. doi: dc192523.
Sabag Angelo, Way Kimberley L, Sultana Rachelle N, Keating Shelley E, Gerofi James A, Chuter Vivienne H, Byrne Nuala M, Baker Michael K, George Jacob, Caterson Ian D, Twigg Stephen M, Johnson Nathan A,
Abstract
OBJECTIVE:
The aim of this study was to examine the effect of a novel low-volume high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), or placebo (PLA) intervention on liver fat, glycemia, and cardiorespiratory fitness using a randomized placebo-controlled design.
RESEARCH DESIGN AND METHODS:
Thirty-five inactive adults (age 54.6 ± 1.4 years, 54% male; BMI 35.9 ± 0.9 kg/m) with obesity and type 2 diabetes were randomized to 12 weeks of supervised MICT ( = 12) at 60% VO for 45 min, 3 days/week; HIIT ( = 12) at 90% VO for 4 min, 3 days/week; or PLA ( = 11). Liver fat percent was quantified through proton MRS.
RESULTS:
Liver fat reduced in MICT (-0.9 ± 0.7%) and HIIT (-1.7 ± 1.1%) but increased in PLA (1.2 ± 0.5%) ( = 0.046). HbA improved in MICT (-0.3 ± 0.3%) and HIIT (-0.3 ± 0.3%) but not in PLA (0.5 ± 0.2%) ( = 0.014). Cardiorespiratory fitness improved in MICT (2.3 ± 1.2 mL/kg/min) and HIIT (1.1 ± 0.5 mL/kg/min) but not in PLA (-1.5 ± 0.9 mL/kg/min) ( = 0.006).
CONCLUSIONS:
MICT or a low-volume HIIT approach involving 12 min of weekly high-intensity aerobic exercise may improve liver fat, glycemia, and cardiorespiratory fitness in type 2 diabetes in the absence of weight loss. Further studies are required to elucidate the relationship between exercise-induced reductions in liver fat and improvements in glycemia.
© 2020 by the American Diabetes Association.
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