Reporting quality of randomized controlled trials in prehabilitation: a scoping review.

BACKGROUND Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists. METHODS Eligibility criteria: RCTs of unimodal or multimodal prehabilitation interventions. SOURCES OF EVIDENCE search was conducted in March 2022 using MEDLINE, Embase, PsychINFO, Web of Science, CINAHL, and Cochrane. CHARTING METHODS identified studies were compared to CONSORT, CERT & Modified CERT, TIDieR, PRESENT, and CONSORT-SPI. An agreement ratio (AR) was defined to evaluate if applicable guideline items were correctly reported. Data were analyzed as frequency (n, %) and mean with standard deviation (SD). RESULTS We identified 935 unique articles and included 70 trials published from 1994 to 2022. Most prehabilitation programs comprised exercise-only interventions (n = 40, 57%) and were applied before oncologic surgery (n = 32, 46%). The overall mean AR was 57% (SD: 20.9%). The specific mean ARs were as follows: CONSORT: 71% (SD: 16.3%); TIDieR: 62% (SD:17.7%); CERT: 54% (SD: 16.6%); Modified-CERT: 40% (SD:17.8%); PRESENT: 78% (SD: 8.9); and CONSORT-SPI: 47% (SD: 22.1). CONCLUSION Altogether, existing prehabilitation trials report approximately half of the checklist items recommended by methodological and intervention reporting guidelines. Reporting practices may improve with the development of a reporting checklist specific to prehabilitation interventions

Outcomes reported in randomised trials of surgical prehabilitation: a scoping review

BACKGROUND: Heterogeneity of reported outcomes can impact the certainty of evidence for prehabilitation. The objective of this scoping review was to systematically map outcomes and assessment tools used in trials of surgical prehabilitation. METHODS: MEDLINE, EMBASE, PsychInfo, Web of Science, CINAHL, and Cochrane were searched in February 2023. Randomised controlled trials of unimodal or multimodal prehabilitation interventions (nutrition, exercise, psychological support) lasting at least 7 days in adults undergoing elective surgery were included. Reported outcomes were classified according to the International Society for Pharmacoeconomics and Outcomes Research framework. RESULTS: We included 76 trials, mostly focused on abdominal or orthopaedic surgeries. A total of 50 different outcomes were identified, measured using 184 outcome assessment tools. Observer-reported outcomes were collected in 86% of trials (n=65), with hospital length of stay being most common. Performance outcomes were reported in 80% of trials (n=61), most commonly as exercise capacity assessed by cardiopulmonary exercise testing. Clinician-reported outcomes were included in 78% (n=59) of trials and most frequently included postoperative complications with Clavien-Dindo classification. Patient-reported outcomes were reported in 76% (n=58) of trials, with health-related quality of life using the 36- or 12-Item Short Form Survey being most prevalent. Biomarker outcomes were reported in 16% of trials (n=12) most commonly using inflammatory markers assessed with C-reactive protein. CONCLUSIONS: There is substantial heterogeneity in the reporting of outcomes and assessment tools across surgical prehabilitation trials. Identification of meaningful outcomes, and agreement on appropriate assessment tools, could inform the development of a prehabilitation core outcomes set to harmonise outcome reporting and facilitate meta-analyses

Adaptation of mitochondrial expression and ATP production in dedifferentiating vascular smooth muscle cells.

Atherosclerosis is one of the leading causes of morbidity and mortality in the Western world. Although the clinical manifestations of this disease are well documented, the etiology and progression remain to be fully understood. Recently, the mitochondria have been implicated in important cellular processes involved in development of atherosclerosis. Despite the link between mitochondria and atherosclerosis, early phase mechanisms of the disease have yet to be elucidated. The aim of this project was to explore the role of mitochondria in vascular smooth muscle (VSMC) dedifferentiation. A murine in-vitro model, involving organ culture of aortic tissue in serum-free media, was used. Mitochondrial function was measured by high resolution respirometry. Proteins associated with the VSMC phenotype switch, as well as mitochondrial density, were assessed by immunoblotting. The findings show that intrinsic mitochondrial Complex I activity is significantly upregulated during VSMC dedifferentiation. Diminished coupling between phosphorylation and oxidation was also found, indicating a greater ADP:ATP ratio. This data suggests increased leak in the electron transport chain and altered mitochondrial function specifically at Complex I. This project provides important information regarding the role of mitochondria in the early atherosclerotic process and that detectable changes in mitochondrial function and expression are related to VSMC dedifferentiation.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Effects of Dietary Macronutrients on Plasma Lipid Levels and the Consequence for Cardiovascular Disease

Despite gaining focus, cardiovascular disease (CVD) remains the leading cause of death worldwide. Health promotion agencies have traditionally recommended diets that are low in fat in order to reduce CVD risk however, much debate remains about which dietary approaches are the most efficient for effective disease prevention. Common markers of CVD include elevated plasma triglycerides (TG) and low-density lipoprotein (LDL) cholesterol levels, as well as reduced high-density lipoprotein (HDL) cholesterol levels. While weight loss alone can significantly reduce markers of CVD, manipulating dietary macronutrient content contributes to the beneficial effects of weight loss and furthers the improvement of lipid profiles even without the alteration of total caloric intake. Considering the recent attention to diets that are low in carbohydrates rather than fat, it remains to be elucidated the beneficial effects of each diet type when establishing new recommendations for CVD prevention. This review aims to examine the effects of different macronutrient compositions on lipid markers, thus providing insight into the potential roles of various diet types in the targeted prevention against CVD

Increased intrinsic mitochondrial respiratory capacity in skeletal muscle from rats with streptozotocin-induced hyperglycemia

Type I diabetes mellitus (T1DM) is a chronic disorder, characterized by an almost or complete insulin deficiency. Widespread tissue dysfunction and deleterious diabetes-complications are associated with long-term elevations of blood glucose. The aim of this study was to investigate the effects of type I diabetes, as induced by streptozotocin, on the mitochondria in skeletal muscles that predominantly consist of either slow or fast twitch fibers. Soleus (primarily slow twitch fiber type) and the plantaris muscle (mainly fast twitch fiber type) were removed in order to measure mitochondrial protein expression and integrated mitochondrial respiratory function. Mitochondrial capacity for oxidative phosphorylation (OXPHOS) was found to be higher in the slow (more oxidative) soleus muscle from STZ rats when evaluating lipid and complex I linked OXPHOS capacity, whereas no difference was detected between the groups when evaluating the more physiological complex I and II linked OXPHOS capacity. These findings indicate that chronic hyperglycemia results in an elevated intrinsic mitochondrial respiratory capacity in both soleus and, at varying degree, plantaris muscle, findings that are consistent with human T1DM patients

Psoas muscle measurement as a marker of sarcopenia predicts risk of Grade 4 or 5 baseline chronic kidney disease and its progression

Abstract Background Psoas muscle area (PMA) has recently been found to be an appropriate surrogate for whole‐body skeletal muscle mass and a measure of sarcopenia. Sarcopenia, which includes a decreased muscle mass and correlated with physical disability, morbidity, and mortality, is prevalent in and has deleterious consequences for patients with chronic kidney disease (CKD). The current study investigates the association of PMA, as a marker of sarcopenia, with baseline kidney function and CKD progression. Methods A retrospective cohort study was conducted in a community hospital nephrology clinic setting. For this study, sarcopenia was defined as standardized PMA measured at the L3 level either as below 25th percentile or below the median. Progression of CKD was measured by estimated glomerular filtration rate (eGFR) decline rate and change in proteinuria. To assess sarcopenia as a predictor of baseline CKD Grade 4 or 5, a multivariate logistic regression model was applied using standardized PMA 29.9 kg/m2 were categorized by 4.8% (11/229), 24.89% (57/229), 33.19% (76/229), and 37.12% (85/229), respectively. Sarcopenia as a predictor of baseline CKD Grade 4 or 5 had an unadjusted odds ratio of 1.46 (0.87–2.63) and an adjusted odds ratio of 2.45 (1.13–5.31). Sarcopenia as a predictor for eGFR slope had an unadjusted odds ratio of 1.01 (1.00–1.04) and an adjusted odds ratio 1.03 (1.00–1.05). Conclusions Sarcopenia, as measured by PMA, predicts a significant risk of more severe baseline CKD grade and progression. Future studies should examine sex‐specific muscle mass tools as a predictor of renal function to create more targeted interventions