Rationale and design of the Exercise Intensity Trial (EXCITE): A randomized trial comparing the effects of moderate versus moderate to high-intensity aerobic training in women with operable breast cancer

<p>Abstract</p> <p>Background</p> <p>The Exercise Intensity Trial (EXcITe) is a randomized trial to compare the efficacy of supervised moderate-intensity aerobic training to moderate to high-intensity aerobic training, relative to attention control, on aerobic capacity, physiologic mechanisms, patient-reported outcomes, and biomarkers in women with operable breast cancer following the completion of definitive adjuvant therapy.</p> <p>Methods/Design</p> <p>Using a single-center, randomized design, 174 postmenopausal women (58 patients/study arm) with histologically confirmed, operable breast cancer presenting to Duke University Medical Center (DUMC) will be enrolled in this trial following completion of primary therapy (including surgery, radiation therapy, and chemotherapy). After baseline assessments, eligible participants will be randomized to one of two supervised aerobic training interventions (moderate-intensity or moderate/high-intensity aerobic training) or an attention-control group (progressive stretching). The aerobic training interventions will include 150 mins.wk^-1of supervised treadmill walking per week at an intensity of 60%-70% (moderate-intensity) or 60% to 100% (moderate to high-intensity) of the individually determined peak oxygen consumption (VO_2peak) between 20-45 minutes/session for 16 weeks. The progressive stretching program will be consistent with the exercise interventions in terms of program length (16 weeks), social interaction (participants will receive one-on-one instruction), and duration (20-45 mins/session). The primary study endpoint is VO_2peak, as measured by an incremental cardiopulmonary exercise test. Secondary endpoints include physiologic determinants that govern VO_2peak, patient-reported outcomes, and biomarkers associated with breast cancer recurrence/mortality. All endpoints will be assessed at baseline and after the intervention (16 weeks).</p> <p>Discussion</p> <p>EXCITE is designed to investigate the intensity of aerobic training required to induce optimal improvements in VO_2peakand other pertinent outcomes in women who have completed definitive adjuvant therapy for operable breast cancer. Overall, this trial will inform and refine exercise guidelines to optimize recovery in breast and other cancer survivors following the completion of primary cytotoxic therapy.</p> <p>Trial Registration</p> <p>NCT01186367</p

The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design

<p>Abstract</p> <p>Background</p> <p>The Lung Cancer Exercise Training Study (LUNGEVITY) is a randomized trial to investigate the efficacy of different types of exercise training on cardiorespiratory fitness (VO_2peak), patient-reported outcomes, and the organ components that govern VO_2peakin post-operative non-small cell lung cancer (NSCLC) patients.</p> <p>Methods/Design</p> <p>Using a single-center, randomized design, 160 subjects (40 patients/study arm) with histologically confirmed stage I-IIIA NSCLC following curative-intent complete surgical resection at Duke University Medical Center (DUMC) will be potentially eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of four conditions: (1) aerobic training alone, (2) resistance training alone, (3) the combination of aerobic and resistance training, or (4) attention-control (progressive stretching). The ultimate goal for all exercise training groups will be 3 supervised exercise sessions per week an intensity above 70% of the individually determined VO_2peakfor aerobic training and an intensity between 60 and 80% of one-repetition maximum for resistance training, for 30-45 minutes/session. Progressive stretching will be matched to the exercise groups in terms of program length (i.e., 16 weeks), social interaction (participants will receive one-on-one instruction), and duration (30-45 mins/session). The primary study endpoint is VO_2peak. Secondary endpoints include: patient-reported outcomes (PROs) (e.g., quality of life, fatigue, depression, etc.) and organ components of the oxygen cascade (i.e., pulmonary function, cardiac function, skeletal muscle function). All endpoints will be assessed at baseline and postintervention (16 weeks). Substudies will include genetic studies regarding individual responses to an exercise stimulus, theoretical determinants of exercise adherence, examination of the psychological mediators of the exercise - PRO relationship, and exercise-induced changes in gene expression.</p> <p>Discussion</p> <p>VO_2peakis becoming increasingly recognized as an outcome of major importance in NSCLC. LUNGEVITY will identify the optimal form of exercise training for NSCLC survivors as well as provide insight into the physiological mechanisms underlying this effect. Overall, this study will contribute to the establishment of clinical exercise therapy rehabilitation guidelines for patients across the entire NSCLC continuum.</p> <p>Trial Registration</p> <p>NCT00018255</p

Changes in CEBPB expression in circulating leukocytes following eccentric elbow-flexion exercise

This is the final version of the article. Available from Springer via the DOI in this record.In mouse models, CCAAT enhancer-binding protein beta (CEBPB) is necessary for M2 macrophage-mediated regeneration after muscle injury. In humans, CEBPB expression in blood was strongly associated with muscle strength. In this study we aimed to test whether CEBPB expression in blood in people is increased 2 days after exercise designed to induce muscle damage and subsequent repair. Sixteen healthy male volunteers undertook elbow flexor exercises designed to induce acute muscle micro-damage. Peripheral blood samples were collected at baseline and days 1, 2, 4 and 7 following exercise. Expression of CEBPB and related genes were analysed by qRT-PCR. Extent of muscle damage was determined by decline in maximal voluntary isometric torque and by plasma creatine kinase activity. Nine subjects had peak (day 4) creatine kinase activity exceeding 10,000 U/l. In this subgroup, CEBPB expression was elevated from baseline to 2 days post exercise (paired-samples t (1,8) = 3.72, p = 0.006). Related expression and selected cytokine changes after exercise did not reach significance. Muscle-damaging exercise in humans can be followed by induction of CEBPB transcript expression in peripheral blood. Associations between CEBPB expression in blood and muscle strength may be consistent with the CEBPB-dependent muscle repair process.Wellcome TrustNational Institute for Health Researc

All soft contact lenses are not created equal

Soft contact lenses that have been prescribed by eye care practitioners are sometimes substituted for alternative lenses by unqualified, unregulated and sometimes even fully regulated lens suppliers, in the mistaken belief that there is essentially no difference between different soft lens types. This review considers the implications of inappropriately substituting soft contact lens types in terms of (a) lens properties: surface treatment, internal wetting agents, material, total diameter, back optic zone radius, thickness, edge profile, back surface design, optical design, power, colour (tint) and ultraviolet protection; and (b) lens usage: wearing modality (daily versus overnight wear) and replacement frequency. Potential aspects of patient dissatisfaction and adverse events when prescribed soft lenses are substituted for lenses with different properties or intended usage are considered. Substitution of 15 of the 16 lens properties considered (i.e. except for back surface design) was found to be related to at least one – and as many as six – potential sources of patient dissatisfaction and adverse ocular events. Contact lens are medical devices which are prescribed and fitted; they should never be substituted for another lens type in the absence of a new prescription further to a full finalised fitting, for the simple reason that all soft contact lenses are not created equal. A substituted lens may have properties that results in undesirable consequences in respect of vision, ocular health, comfort and cosmetic appearance, and may be incompatible with the lifestyle of the patient

Assisted extraction of the energy level spacings and lever arms in direct current bias measurements of one-dimensional quantum wires, using an image recognition routine

A multiplexer technique is used to individually measure an array of 256 split gates on a single GaAs/AlGaAs heterostructure. This results in the generation of large volumes of data, which requires the development of automated data analysis routines. An algorithm is developed to find the spacing between discrete energy levels, which form due to transverse confinement from the split gate. The lever arm, which relates split gate voltage to energy, is also found from the measured data. This reduces the time spent on the analysis. Comparison with estimates obtained visually show that the algorithm returns reliable results for subband spacing of split gates measured at 1:4 K. The routine is also used to assess DC bias spectroscopy measurements at lower temperatures (50 mK). This technique is versatile and can be extended to other types of measurements. For example, it is used to extract the magnetic field at which Zeeman-split 1D subbands cross one another.This work was supported by the Engineering and Physical Sciences Research Council grant No. EP/IO14268/1.This is the accepted manuscript. The final version is available from AIP at http://scitation.aip.org/content/aip/journal/jap/117/1/10.1063/1.4905484

Statistical study of conductance properties in one-dimensional quantum wires focusing on the 0.7 anomaly

The properties of conductance in one-dimensional (1D) quantum wires are statistically investigated using an array of 256 lithographically-identical split gates, fabricated on a GaAs/AlGaAs heterostructure. All the split gates are measured during a single cooldown under the same conditions. Electron many-body effects give rise to an anomalous feature in the conductance of a one-dimensional quantum wire, known as the `0.7 structure' (or `0.7 anomaly'). To handle the large data set, a method of automatically estimating the conductance value of the 0.7 structure is developed. Large differences are observed in the strength and value of the 0.7 structure [from $0.63$ to $0.84\times (2e^2/h)$], despite the constant temperature and identical device design. Variations in the 1D potential profile are quantified by estimating the curvature of the barrier in the direction of electron transport, following a saddle-point model. The 0.7 structure appears to be highly sensitive to the specific confining potential within individual devices.This is the author's accepted manuscript. The final version is published by ACS in Physical Review B and can be found here: http://journals.aps.org/prb/abstract/10.1103/PhysRevB.90.045426

Effect of Split Gate Size on the Electrostatic Potential and 0.7 Anomaly within Quantum Wires on a Modulation-Doped GaAs/AlGaAs Heterostructure

© 2016 American Physical Society. © 2016 American Physical Society.We study 95 split gates of different size on a single chip using a multiplexing technique. Each split gate defines a one-dimensional channel on a modulation-doped GaAs/AlGaAs heterostructure, through which the conductance is quantized. The yield of devices showing good quantization decreases rapidly as the length of the split gates increases. However, for the subset of devices showing good quantization, there is no correlation between the electrostatic length of the one-dimensional channel (estimated using a saddle-point model) and the gate length. The variation in electrostatic length and the one-dimensional subband spacing for devices of the same gate length exceeds the variation in the average values between devices of different lengths. There is a clear correlation between the curvature of the potential barrier in the transport direction and the strength of the "0.7 anomaly": the conductance value of the 0.7 anomaly reduces as the barrier curvature becomes shallower. These results highlight the key role of the electrostatic environment in one-dimensional systems. Even in devices with clean conductance plateaus, random fluctuations in the background potential are crucial in determining the potential landscape in the active device area such that nominally identical gate structures have different characteristics

Dependence of the 0.7 anomaly on the curvature of the potential barrier in quantum wires

. Ninety-eight one-dimensional channels defined using split gates fabricated on a GaAs/AlGaAs heterostructure are measured during one cooldown at 1.4 K. The devices are arranged in an array on a single chip and are individually addressed using a multiplexing technique. The anomalous conductance feature known as the "0.7 structure" is studied using statistical techniques. The ensemble of data shows that the 0.7 anomaly becomes more pronounced and occurs at lower values as the curvature of the potential barrier in the transport direction decreases. This corresponds to an increase in the effective length of the device. The 0.7 anomaly is not strongly influenced by other properties of the conductance related to density. The curvature of the potential barrier appears to be the primary factor governing the shape of the 0.7 structure at a given T and B.his work was supported by Engineering and Physical Sciences Research Council Grant No. EP/I014268/1