Monitoring the heart rate variability responses to training loads in competitive swimmers using a smartphone application and the Banister Impulse-Response model

Purpose: First, to examine whether heart rate variability (HRV) responses can be modeled effectively via the Banister impulse-response model when the session rating of perceived exertion (sRPE) alone, and in combination with subjective well-being measures, are utilized. Second, to describe seasonal HRV responses and their associations with changes in critical speed (CS) in competitive swimmers. Methods: A total of 10 highly trained swimmers collected daily 1-minute HRV recordings, sRPE training load, and subjective well-being scores via a novel smartphone application for 15 weeks. The impulse-response model was used to describe chronic root mean square of the successive differences (rMSSD) responses to training, with sRPE and subjective well-being measures used as systems inputs. Changes in CS were obtained from a 3-minute all-out test completed in weeks 1 and 14. Results: The level of agreement between predicted and actual HRV data was R2 = .66 (.25) when sRPE alone was used. Model fits improved in the range of 4% to 21% when different subjective well-being measures were combined with sRPE, representing trivial-to-moderate improvements. There were no significant differences in weekly group averages of log-transformed (Ln) rMSSD (P = .34) or HRV coefficient of variation of Ln rMSSD (P = .12); however, small-to-large changes (d = 0.21–1.46) were observed in these parameters throughout the season. Large correlations were observed between seasonal changes in HRV measures and CS (changes in averages of Ln rMSSD: r = .51, P = .13; changes in coefficient of variation of Ln rMSSD: r = −.68, P = .03). Conclusion: The impulse-response model and data collected via a novel smartphone application can be used to model HRV responses to swimming training and nontraining-related stressors. Large relationships between seasonal changes in measured HRV parameters and CS provide further evidence for incorporating a HRV-guided training approach

18F-FDG PET/CT role in staging of gastric carcinomas: comparison with conventional contrast enhancement computed tomography

The purpose of the report was to evaluate the role of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) in staging gastric cancer comparing it with contrast enhancement computed tomography (CECT).This retrospective study included 45 patients who underwent performed whole body CECT and F-FDG PET/CT before any treatment. We calculated CECT and F-FDG PET/CT sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) for gastric, lymphnode, and distant localizations; furthermore, we compared the 2 techniques by McNemar test. The role of F-FDG PET/CT semiquantitative parameters in relation to histotype, grading, and site of gastric lesions were evaluated by ANOVA test.Sensitivity, specificity, accuracy, PPV and NPV of CECT, and F-FDG PET/CT for gastric lesion were, respectively, 92.11%, 57.14%, 86.66%, 92.11%, 57.14% and 81.58%, 85.71%, 82.22%, 96.88%, 46.15%. No differences were identified between the 2 techniques about sensitivity and specificity. No statistical differences were observed between PET parameters and histotype, grading, and site of gastric lesion. The results of CECT and F-FDG PET/CT about lymphnode involvement were 70.83%, 61.90%, 66.66%, 68%, 65% and 58.33%, 95.24%, 75.55%, 93.33%, 66.67%. The results of CECT and F-FDG PET/CT about distant metastases were 80%, 62.86%, 66.66%, 38.10%, 91.67% and 60%, 88.57%, 82.22%, 60%, 88.57%. FDG PET/CT specificity was significantly higher both for lymphnode and distant metastases.The F-FDG PET/CT is a useful tool for the evaluation of gastric carcinoma to detect primary lesion, lymphnode, and distant metastases using 1 single image whole-body technique. Integration of CECT with F-FDG PET/CT permits a more valid staging in these patients

Monitoring the heart rate variability responses to training loads in competitive swimmers using a smartphone application and the Banister Impulse-Response model

Purpose: First, to examine whether heart rate variability (HRV) responses can be modeled effectively via the Banister impulse-response model when the session rating of perceived exertion (sRPE) alone, and in combination with subjective well-being measures, are utilized. Second, to describe seasonal HRV responses and their associations with changes in critical speed (CS) in competitive swimmers. Methods: A total of 10 highly trained swimmers collected daily 1-minute HRV recordings, sRPE training load, and subjective well-being scores via a novel smartphone application for 15 weeks. The impulse-response model was used to describe chronic root mean square of the successive differences (rMSSD) responses to training, with sRPE and subjective well-being measures used as systems inputs. Changes in CS were obtained from a 3-minute all-out test completed in weeks 1 and 14. Results: The level of agreement between predicted and actual HRV data was R2 = .66 (.25) when sRPE alone was used. Model fits improved in the range of 4% to 21% when different subjective well-being measures were combined with sRPE, representing trivial-to-moderate improvements. There were no significant differences in weekly group averages of log-transformed (Ln) rMSSD (P = .34) or HRV coefficient of variation of Ln rMSSD (P = .12); however, small-to-large changes (d = 0.21–1.46) were observed in these parameters throughout the season. Large correlations were observed between seasonal changes in HRV measures and CS (changes in averages of Ln rMSSD: r = .51, P = .13; changes in coefficient of variation of Ln rMSSD: r = −.68, P = .03). Conclusion: The impulse-response model and data collected via a novel smartphone application can be used to model HRV responses to swimming training and nontraining-related stressors. Large relationships between seasonal changes in measured HRV parameters and CS provide further evidence for incorporating a HRV-guided training approach

Heart Rate Variability is a Moderating Factor in the Workload-Injury Relationship of Competitive CrossFit Athletes

Heart rate variability (HRV) is a popular tool for monitoring training adaptation and readiness in athletes, but it also has the potential to indicate early signs of somatic tissue overload prior to the onset of pain or fully developed injury. Therefore, the aim of this study was to investigate the interaction between HRV, workloads, and risk of overuse problems in competitive CrossFit™ athletes. Daily resting HRV and workloads (duration × session-RPE) were recorded in six competitive CrossFit™ athletes across a 16 week period. The Oslo Sports Trauma Research Center Overuse Injury Questionnaire was distributed weekly by e-mail. Acute-to-chronic workload ratios (ACWR) and the rolling 7-day average of the natural logarithm of the square root of the mean sum of the squared differences between R–R intervals (Ln rMSSDweek) were parsed into tertiles (low, moderate/normal, and high) based on within-individual z-scores. The interaction between Ln rMSSDweek and ACWR on overuse injury risk in the subsequent week was assessed using a generalized linear mixed-effects model and magnitude-based inferences. The risk of overuse problems was substantially increased when a ‘low’ Ln rMSSDweek was seen in combination with a ‘high’ ACWR (relative risk [RR]: 2.61, 90% CI: 1.38 – 4.93). In contrast, high ACWRs were well-tolerated when Ln rMSSDweek remained ‘normal’ or was ‘high’. Monitoring HRV trends alongside workloads may provide useful information on an athlete’s emerging global pattern to loading. HRV monitoring may therefore be used by practitioners to adjust and individualise training load prescriptions, in order to minimise overuse injury risk

Cardiovascular risk evaluation and prevalence of silent myocardial ischemia in subjects with asymptomatic carotid artery disease

Introduction: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis. Methods: A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries. Results: A statistically significant relationship (P = 0.023) was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively. Conclusion: The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in patients with asymptomatic carotid plaques, considering eventually plaque morphology (symmetry, composition, eccentricity or concentricity of the plaque, etc) for patient stratification.Introduction: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis. Methods: A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries. Results: A statistically significant relationship (P = 0.023) was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively. Conclusion: The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in patients with asymptomatic carotid plaques, considering eventually plaque morphology (symmetry, composition, eccentricity or concentricity of the plaque, etc) for patient stratification. © 2011 Ciccone et al, publisher and licensee Dove Medical Press Ltd

Real-world treatment patterns for metastatic non-small cell lung cancer at IRST Italy

n/

Chemotherapy and palliative care near end-of life: Examining the appropriateness at a cancer institute for colorectal cancer patients

Background: Appropriate cessation of chemotherapy and timely referral of patients to hospice services are crucial for the quality of care near death. We investigated the quality of care in our Cancer Institute in very advanced metastatic colorectal cancer patients treated in real life. Patients and Methods: We performed a retrospective analysis of electronic medical data of patients with metastatic colorectal cancer who were candidates for chemotherapy during the study period (1 January 2007-30 June 2014) and died before 31 December 2014. Quality-of-cancer-care indicators were calculated for the overuse of chemotherapy and referral to hospice. Predictive factors of chemotherapy discontinuation and hospice referral in end-of life care were investigated using parametric and nonparametric methods. Results: Of the 365 patients who died before 31 December 2014, 26 (7.1%) received chemotherapy in the last 14 days of life and 36 (9.8%) started a new chemotherapy regimen in the last 30 days of life. Factors associated with the overuse of chemotherapy were being < 70 years of age for both indicators and not having received advanced chemotherapy treatments for the former indicator. The majority of patients (74.7%) had access to hospice services, of whom only a small percentage (7.2%) accessed them very near to death. Conclusions: According to the criteria used, our Institute provides a good quality of cancer care for dying colorectal cancer patients, measured by the use of chemotherapy and referral to hospice in their last days of life

Editorial: Measure do not guess: a call to action to end assumed and estimated menstrual cycle phases in research

Several studies have been published in the last year using assumed or estimated menstrual cycle phases. These phases are ‘generated’ solely on regular menstruation. As more of these studies are published, founded on data that was not actually measured, it becomes imperative to grasp the difference between what is measured versus what is assumed or estimated. We need to measure, not guess, to draw valid and meaningful conclusions in a research topic that is riddled with considerable debate over contradicting outcomes. Hence, this editorial is a call to action directed at editors and reviewers. It is intended to raise the quality, practical implications, application and integrity of future studies investigating the effect of menstrual cycle phases on a given outcome. We do not intend to focus on individual papers but want to ensure that female populations can use their reproductive data accurately and effectively

An 1H NMR study of the cytarabine degradation in clinical conditions to avoid drug waste, decrease therapy costs and improve patient compliance in acute leukemia

Cytarabine, the 4-amino-1-(β-D-arabinofuranosyl)-2(1H)-pyrimidinone, (ARA-C) is an antimetabolite cytidine analogue used worldwide as key drug in the management of leukaemia. As specified in the manufacturers' instructions, once the components-sterile water and cytarabine powder-are unpackaged and mixed, the solution begins to degrade after 6 hours at room temperature and 12 hours at 4°C. To evaluate how to avoid wasting the drug in short-term, low-dose treatment regimens, the reconstituted samples, stored at 25°C and 4°C, were analyzed every day of the test week by reversed-phase HPLC and high-field NMR spectroscopy. All the samples remained unchanged for the entire week, which corresponds to the time required to administer the entire commercial drug package during low-dose therapeutic regimens. The drug solution was stored in a glass container at 4°C in an ordinary freezer and drawn with sterile plastic syringes; during this period, no bacterial or fungal contamination was observed. Our findings show that an cytarabine solution prepared and stored in the original vials retains its efficacy and safety and can, therefore, be divided into small doses to be administered over more days, thus avoiding unnecessary expensive and harmful waste of the drug preparation. Moreover, patients who require daily administration of the drug could undergo the infusion at home without need to go to hospital. The stability of the aliquots would help decrease hospitalization costs