Effects of physical exercise on serum levels of serotonin and its metabolite in fibromyalgia: a randomized pilot study

To evaluate the effects of aerobic training and stretching on serum levels of serotonin (5HT) and its main metabolite 5-hydroxindolacetic acid (5HIAA). Twenty-two women with FM were randomized into one of two exercise modalities (aerobic walking exercise or stretching exercise) to be accomplished three times a week for 20 weeks. The serum levels of 5HT and 5HIAA were evaluated before and after the exercise program by high performance liquid chromatography (HPLC) with colorimetric detection. Within group analysis (pre-post) showed that serum levels of both 5HT and 5HIAA changed signifi cantly in the aerobic group during the 20-week course of therapy (5HT: P = 0,03; 5HIAA: P = 0,003). In the stretching group, however, no statistically signifi cant change was observed (5HT: P=0,491; 5HIAA: P=0,549). Between group statistical comparisons of laboratory measures disclosed that aerobic training was superior to stretching in that it signifi - cantly increased the levels of 5HIAA (F test = 6.61; P = 0.01), but the average difference between groups on the levels of 5HT did not meet signifi cance criteria (F test = 3.42; P = 0.08). Aerobic training increases the 5HIAA and 5HT levels and it could explain why aerobic exercise can improve symptoms in fi bromyalgia syndrome patient more than stretching exerciseAvaliar os efeitos do treinamento aeróbico e do alongamento sobre os níveis séricos de serotonina (5-HT) e seu principal metabólito ácido 5-hidroxiindolacético (5-HIAA). Foram randomizadas 22 mulheres com fibromialgia (FM) em uma de duas modalidades de exercício (exercício aeróbico de caminhada ou exercício de alongamento) a serem realizadas três vezes por semana, por 20 semanas. Os níveis séricos de 5-HT e 5-HIAA foram avaliados antes e após o programa de exercícios por cromatografia líquida de alta eficiência (CLAE) com detecção colorimétrica. A análise de grupo (pré-pós) mostrou que os níveis séricos de 5-HT e 5-HIAA mudaram significativamente no grupo aeróbico durante o período de 20 semanas de terapia (5-HT: p = 0,03; 5-HIAA: p = 0,003). No grupo alongamento, contudo, não foi observada qualquer alteração estatisticamente significativa (5-HT: p = 0,491; 5-HIAA: p = 0,549). Comparações estatísticas das medidas de laboratório entre os grupos constataram que o treinamento aeróbico foi superior ao alongamento, aumentando significativamente os níveis de 5-HIAA (teste F - 6,61; p = 0,01); porém, a diferença média entre os grupos a respeito dos níveis de 5-HT não atendeu aos critérios de relevância (teste F = 3,42; p = 0,08). O treinamento aeróbico aumenta os níveis de 5-HIAA e 5-HT e poderia explicar porque o exercício aeróbico pode melhorar os sintomas de pacientes com síndrome de fibromialgia mais que o exercício de alongamento.Universidade Federal do Espírito Santo Departamento de ReumatologiaUniversidade Federal de São Paulo (UNIFESP)University of Texas Health Science Center at San AntonioUFES Departamento de DermatologiaUFES Departamento de EstatísticaUNIFESPSciEL

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)