ASO Author Reflections: Impact of a Preoperative Home-Based Exercise Program on Quality of Life After Lung Cancer Resection

Surgical resection is the cornerstone of curative treatment for patients with lung cancer. Nevertheless, it often leads to functional limitations and symptoms of pain, fatigue, and dyspnea, which have a detrimental impact on patients’ health-related quality of life (HRQoL).info:eu-repo/semantics/publishedVersio

Classification, Diagnosis and Risk Assessment Methods in Diseases with Visual Impairment

Tese de doutoramento em Ciências da Saúde, no ramo de Ciências Biomédicas, apresentada à Faculdade de Medicina da Universidade de CoimbraAs doenças da visão incluem a cegueira e a baixa visão, e afetam cerca de 4,25% da população mundial. Cerca de 80% destas podem ser prevenidas ou curadas. Estas estimativas, da Organização Mundial de Saúde, referem que 82% das pessoas com cegueira têm 50 ou mais anos. A sua prevalência está relacionada com o envelhecimento da população, emergindo neste contexto as doenças do segmento posterior. Nestas, inclui-se a retinopatia diabética, uma manifestação clínica da diabetes mellitus. Esta doença sistémica é a principal causa de novos casos de cegueira em todo o mundo, entre os 20 e os 74 anos de idade, sendo a complicação referida causada por danos acumulados ao longo do tempo sobretudo nos pequenos vasos sanguíneos na retina. A diabetes, especialmente do tipo 2, está entre as principais causas de morte e de invalidez, apresentando um elevado peso económico em todo o mundo. Teme-se que esta doença se torne epidémica, dado o aumento da sua incidência e prevalência devido ao crescimento e ao envelhecimento das populações, e ainda a alterações no estilo de vida tais como a redução da atividade física e o aumento da obesidade. Assim, a retinopatia diabética foi adicionada à lista de prioridades no que diz respeito a doenças da visão evitáveis. As últimas estimativas de prevalência de diabetes na população portuguesa entre os 20 e os 79 anos datam de 2012, e referem uma prevalência de 12,9%, representando um aumento de 1,2% desde 2009. Neste ano, a retinopatia diabética foi referida como a principal causa de cegueira na população portuguesa em idade ativa. A necessidade de diagnosticar precocemente ambas as doenças é fundamental em todos os contextos socioeconómicos, a fim de reduzir os seus custos diretos e, principalmente, os custos indiretos e intangíveis, quer para os diabéticos e seus familiares, quer para os Serviços Nacionais de Saúde. Apesar de os métodos para diagnóstico destas doenças estarem claramente definidos, a necessidade de encontrar novos marcadores e classificadores não invasivos, utilizados para rastreio noutros contextos médicos, tornou-se de extrema importância. Para construir um modelo que identificasse marcadores da diabetes tipo 2, utilizou-se uma amostra de treino constituída por 96 casos, dos quais 49 eram diabéticos tipo 2, com idade compreendida entre os 40 e os 75 anos. O grupo de diabéticos foi usado para o desenvolvimento de um classificador de retinopatia diabética em diabéticos tipo 2, na mesma faixa etária, sendo a amostra constituída por 40 sujeitos, dos quais 20 tinham retinopatia diabética não-proliferativa. Foi avaliada a correlação e concordância entre as medidas obtidas para os olhos direito e esquerdo, obtidas por Tomografia de Coerência Óptica, concluindo-se que um olho era suficiente para a análise. Foi seleccionado o olho dominante, já que os testes visuais psicofísicos foram realizados apenas neste olho. Foi construída uma medida global do desempenho para cada teste psicofísico (velocidade, visão acromática e visão cromática nos eixos Protan, Deutan e Tritan) com base nos valores obtidos para os meridianos 0º, 45º, 90º e 135º, em cada sujeito. Posteriormente, foi necessário proceder a uma redução de variáveis, tendo-se comparado os grupos através do teste t-Student para amostras independentes ou do teste de Mann-Whitney, de acordo com a distribuição amostral. Apenas prosseguiram em análise as variáveis que apresentaram diferença estatisticamente significativa entre os grupos, ao nível de significância de 5%. Subsequentemente, foi usada a análise Receiver Operating Characteristic (ROC), com o mesmo nível de significância, e identificou-se o conjunto das variáveis que, individualmente, podiam separar os grupos. Tornou-se assim possível a aplicação de métodos de classificação estatística, tais como a análise discriminante, a regressão logística e a utilização de algoritmos de árvore de decisão, ao conjunto de variáveis remanescentes. O desempenho dos classificadores estatísticos obtidos para a diabetes tipo 2 foi comparado, quer na amostra de treino, quer num conjunto de novos indivíduos participantes. O desempenho dos classificadores para a retinopatia diabética não proliferativa foi avaliado apenas na amostra de treino, mas tenciona-se também testá-lo, futuramente, num conjunto de novos sujeitos. O desempenho dos classificadores foi avaliado através da avaliação da sua acuidade, determinada pela área sob a curva ROC obtida para as probabilidades a posteriori de cada um dos modelos, e pela sensibilidade e razão de verossimilhança positiva determinada para as classificações nos grupos. Um classificador final é apresentado, quer para diabéticos tipo 2 com idades entre 40 e 75 anos de idade, quer para a retinopatia diabética não-proliferativa em diabéticos tipo 2, na mesma faixa etária, assim como os seus valores preditivos positivos ajustados para os dados mais recentes da prevalência de cada doença na população portuguesa. A visão cromática relativa ao eixo dos cones Tritan parece desempenhar um papel dominante para a classificação de ambas as doenças.Visual impairment, which includes blindness and low vision, affects about 4.25% of the world population, and about 80% is avoidable, since it can be prevented or cured. Those estimates, from the World Health Organization, refer that 82% of blind people are aged 50 or more. The largest proportion of visual impairment is necessarily related to the increase of the ageing of populations, and where posterior segment (retinal) diseases dominate. Among these diseases, there is diabetic retinopathy, an ocular manifestation of diabetes mellitus. This systemic disease, is the leading cause of new cases of blindness around the world in persons aged between 20 and 74 years old, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. Furthermore, the eye is considered to play an important role in the diagnostic of systemic diseases due to its composition. Every part of the eye is able to give important clues for diagnosis. Diabetes mellitus, especially type 2, is among the leading causes of death, disability and economic loss throughout the world. It is feared to become an epidemic disease, since its incidence and prevalence are increasing, mainly due to population growth and ageing, as well as a result of alterations in lifestyle, which are leading to the reduction of physical activity and to the increase of obesity. With its increase, diabetic retinopathy was gained a prominent role in the list of preventable visual impairment. The latest prevalence estimates for diabetes in the Portuguese population aged between 20 and 79 years date from 2012, and referred a value of 12.9%, which represents an increment of 1.2% since 2009. In fact, in 2009, diabetic retinopathy was referred as the leading cause of blindness for the Portuguese population in active age. The need for early diagnosis of both the diseases and its ocular complications is crucial in all socioeconomic contexts, in order to reduce its burden due to its direct costs, and mainly due to its indirect and intangible costs, either for diabetics and their families, or for the National Health Services. In spite of the fact that methods for diagnosing those diseases are clearly defined, the need to find new markers and non-invasive classifiers used for screening in other medical contexts has become of extreme importance. A training sample for determination of markers for type 2 diabetes was used, comprising 96 cases, of which 49 were type 2 diabetics, aged between 40 and 75 years old. The group of diabetics was used to build a classifier for diabetic retinopathy in type 2 diabetics in the same age group, and the sample comprised 40 subjects from which 20 had non-proliferative diabetic retinopathy. Correlation and concordance between measures obtained by Optical Coherence Tomography in the left and right eyes of the same subjects was evaluated, leading to the conclusion that only one eye was needed for the analysis. Hence, the dominant eye was selected for analysis since visual psychophysics tests were performed only in that eye. A global measure of the performance, for each subject, in each one of the visual psychophysics tests (speed, achromatic vision and chromatic vision over the Protan, Deutan and Tritan axes) was build, based upon values obtained for the 0º, 45º, 90º and 135º meridians. Afterwards, a variable reduction was performed applying an independent samples t test or a Mann-Whitney test, according to data distribution, and only the variables that showed statistical significances, at 5% significance level, were selected to remain in the analysis. Subsequently, a Receiver Operating Characteristic curve was applied to each one of the remaining variables, using the same significance level, and the set of variables which were able to separate groups, individually, was identified. By then, it was possible to apply different statistical classifying methods, such as discriminant analysis, logistic regression and decision tree algorithms. The performance of the classifiers obtained for type 2 diabetes was compared either in the training set, or in a test set of new subjects. Non-proliferative diabetic retinopathy classifiers were only tested on the training sample, at the moment. Hereafter, we intend to test their performance in a set of new cases. The performance of those classifiers was assessed using accuracy measures, determined by the area under the ROC curve for the posterior probabilities of models, and according to its sensitivity and positive likelihood ratio for group classification. A final classifier is presented, either for type 2 diabetics aged between 40 and 75 years, or for non-proliferative diabetic retinopathy in type 2 diabetics for the same age group, as well as its positive predictive values adjusted for the latest data on the Portuguese prevalence for each disease. Whichever the clinical category (presence of disease or complications), chromatic vision over the Tritan cone seems to play a main role for the classification of both diseases

Home-Based Preoperative Exercise Training for Lung Cancer Patients Undergoing Surgery: A Feasibility Trial

Background: Clinical guidelines recommend prehabilitation with exercise training to optimize recovery after lung cancer surgery. However, the lack of access to facility-based exercise programs is a major barrier to routine participation. This study aimed to assess the feasibility of a home-based exercise intervention before lung cancer resection. Methods: We conducted a prospective, two-site feasibility study, including patients scheduled for lung cancer surgery. Exercise prescription involved aerobic and resistance training with telephone-based supervision. The primary endpoint was overall feasibility (recruitment rate, retention rate, intervention adherence and acceptability). Secondary endpoints included safety and effects on health-related quality of life (HRQOL) and physical performance, evaluated at baseline, after the exercise intervention and 4–5 weeks after surgery. Results: Over three months, 15 patients were eligible, and all agreed to participate (recruitment rate: 100%). A total of 14 patients completed the exercise intervention, and 12 patients were evaluated postoperatively (retention rate: 80%). The median length of the exercise intervention was 3 weeks. Patients performed an aerobic and resistance training volume higher than prescribed (median adherence rates of 104% and 111%, respectively). A total of nine adverse events occurred during the intervention (Grade 1, n = 8; Grade 2, n = 1), the most common being shoulder pain. After the exercise intervention, significant improvements were observed in the HRQOL summary score (mean difference, 2.9; 95% confidence interval [CI], from 0.9 to 4.8; p = 0.049) and the five-times sit-to-stand test score (median difference, −1.5; 95% CI, from −2.1 to −0.9; p = 0.001). After surgery, no significant effects on HRQOL and physical performance were observed. Conclusion: A short-term preoperative home-based exercise intervention is feasible before lung cancer resection and may enhance accessibility to prehabilitation. Clinical effectiveness should be investigated in future studies.info:eu-repo/semantics/publishedVersio

The impact of aquatic exercise programs on the intima-media thickness of the carotid arteries, hemodynamic parameters, lipid profile and chemokines of community-dwelling older persons: a randomized controlled trial

Scientific evidence has shown that physical exercise is an effective way of improving several cardiovascular disease markers. However, few studies have tested its effectiveness whenperformed in aquatic environments. The purpose of this study was to test the impact of different aquatic exercise programs on the intima-media thickness of carotid arteries (IMT) and hemodynamic and biochemical markers of cardiovascular diseases in community-dwelling older persons. A total of 102 participants were randomly allocated into four groups: an aerobic exercise group (AerG) (n = 25, 71.44 ± 4.84 years); an aerobic interval group (IntG) (n = 28, 72.64 ± 5.22 years); a combined group (ComG) (n = 29, 71.90 ± 5.67 years); and a control group (CG) (n = 20, 73.60 ± 5.25 years). The AerG, IntG, and ComG participants took part in three different aquatic exercise programs for 28 weeks. The CG participants maintained their usual routines. All participants were evaluated for IMT, blood pressure, lipid profile, and MCP-1 and MIP-1α chemokines, pre- and post-intervention. Significant differences were found in the AerG for diastolic diameter (DD), in the IntG for peak systolic velocity (PSV), and in the ComG for DD and end-diastolic velocity (EDV). Regarding blood pressure, significant differences were found in AerG for systolic blood pressure (SBP) and diastolic blood pressure (DBP); in IntG for DBP; and in ComG for SBP, DBP, and heart rate (HR). Significant differences were found in the AerG and IntG for glucose (GLU). Lower plasma levels of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein (MIP-1α) were found in the AerG and in the ComG for MCP-1 after the intervention. Aquatic physical exercise appears to improve cardiovascular health, regardless of the type of the program adopted. Aerobic programs (combined and continuous aerobic exercises) seemed to have a more beneficial effect in reducing important cardiovascular risk markers.info:eu-repo/semantics/publishedVersio

Higher Metabolic Dysfunction in Adolescents Who Were Born Very Preterm: Case Control Study

Introduction: Literature has shown an increase in cardiovascular risk and metabolic changes in adolescents and young adults who were born preterm. In this regard, the present study aimed to assess metabolic dysfunction in adolescents who were born at less than 32 weeks of gestational age. Methods: This case-control study was performed on adolescents within the age range of 10-17 years and born in a level III maternity, with gestational age of < 32 weeks. Controls were healthy adolescents with gestational age of ≥ 37 weeks. Demographic data, cardiovascular risk history, and clinical data were evaluated and blood tests were performed. Results: In total, 110 preterm and 48 controls were enrolled in the study. Based on the results, mean systolic (118.8 vs 112.6 mmHg, p = 0.001) and diastolic (61.7 vs 58.5 mmHg, p = 0.014) blood pressures were statistically higher in preterm infants, compared to the controls. The preterm adolescents had a higher waist-to-height ratio, fat mass, fasting blood glucose, insulin, homeostasis model assessment for insulin resistance, total cholesterol, low-density lipoprotein, and apolipoprotein B100, compared to the controls. However, none of these differences were statistically significant. It was found that preterm adolescents had more metabolic dysfunction risk factors, compared to the controls (p = 0.007). Discussion: Prematurity contributes to higher cardiovascular risk and metabolic dysfunction. Moreover, higher arterial blood pressure seems to be the most important clinical finding in this study. Close monitoring of risk factors, particularly blood pressure, in adolescents who were born at less than 32 weeks is important for the prevention and early diagnosis of metabolic and cardiovascular comorbidities in adulthood

Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

About 15%-25% of patients with colorectal cancer, have synchronous liver metastases. The best surgical approach for the patients with asymptomatic primary colorectal tumor and synchronous liver metastases is still the subject of much debate. We aimed to evaluate the perioperative and long-term results as well as to identify possible prognostic factors of the two strategies:&nbsp; liver- first and synchronous resection. Observational, retrospective study, which included patients with synchronous liver metastases from colorectal cancer, who underwent liver surgery between January 2016 and December 2021, in a Portuguese reference center. Patients were divided into two groups according to the therapeutic approach (synchronous resections vs Liver First) and into three groups according to the hepatic tumor burden (single liver lesion versus more than three liver lesions versus bilobar lesions). To determine the overall and disease-free survival, Kaplan-Meier curves and the log-rank test were performed and, to identify factors with an impact on the prognosis, a univariate and multivariate analysis were performed with the application of Cox regression (significance of 5%). Among the 46 patients included, 54,4% underwent the liver-first approach and 21 patients (45.7%) underwent simultaneous resection. The liver-first group had a greater number of patients with primary rectal tumor (84% vs.14.3%; p&lt;0.001), with more than 3 hepatic lesions (56% vs.14%; p=0.004) and with more extensive hepatic resection. As for postoperative morbimortality, no statistically significant difference was observed between the two approaches (p=0.514). The median overall survival was similar even when considering the hepatic tumor burden (35.0 months (95%CI 15.91- 54.09) in the liver-first group vs. 48.0 months (95%CI 21.69-74.96) in the synchronous resection group; p=0.145). The same was observed for the median disease-free survival (16.0 months (95% CI 0-32.7) vs. 23.0 months (95% CI 16.3-29.7) p=0.651, respectively). The two strategies showed similar morbidity. No statistically significant difference was observed with regard to overall and disease-free survival even when the hepatic tumor burden was considered. One-year and three-year survival were also similar. However, it should be stressed that, the choice of the surgical approach for each group did not took into account the hepatic tumor burden, which we believe it is essential in choosing the best surgical approach.The existence of a multidisciplinary team is fundamental for the therapeutic success of these patients

Efeito do exercício físico na qualidade de vida após a cirurgia para cancro do pulmão e cancro colorretal: Revisão sistemática

Introdução: O cancro colorretal (CCR) e o cancro do pulmão são atualmente dois dos tumores mais incidentes a nível global e os mais mortais. Apesar da resseção cirúrgica ser uma intervenção potencialmente curativa em pacientes com estes tumores, esta intervenção está associada a um declínio significativo na qualidade de vida relacionada com a saúde (QVRS). O exercício físico (EF) tem demonstrado um efeito benéfico na melhoria da capacidade funcional dos pacientes elegíveis para estes tipos de cirurgia oncológica, desconhecendo-se, no entanto, o seu efeito na recuperação da QVRS. Objectivo: O objetivo principal desta revisão sistemática foi avaliar a eficácia do EF na melhoria da QVRS após a cirurgia, em pacientes diagnosticados cancro do pulmão ou com CCR. Métodos: Foram incluídos estudos randomizados controlados, publicados até 21 de Março de 2021, selecionados através de pesquisa eletrónica, realizada nas bases de dados PubMed, Scopus, Web of Science, SPORTDiscus e PEDro. Os estudos elegíveis teriam de comparar o efeito de intervenções com EF, implementado no período pré-cirúrgico ou nos três primeiros meses após a cirurgia, com intervenções que não envolvessem exercício estruturado durante este período. A qualidade metodológica foi avaliada através da escala Physiotherapy Evidence Database (PEDro). Resultados: Dez estudos cumpriram com os critérios de elegibilidade e obtiveram uma pontuação ≥ 5 (0-10) na escala PEDro. Nove estudos incluíram pacientes com cancro do pulmão (n=651) e um estudo pacientes com CCR (n=93). Em pacientes com cancro do pulmão o exercício físico melhorou significativamente a dimensão física da QVRS após a cirurgia, com um efeito de magnitude elevada (SMD=0.89: 95% CI: [0.61; 1.15]; p=0.00) e reduziu significativamente os sintomas de fadiga, com um efeito de magnitude moderada SMD=-0.30: 95% CI: [-0.51;-0.08]; p=0.01). Em pacientes com CCR não se verificaram alterações significativas na QVRS nem nos sintomas de fadiga. Conclusão: O EF revela ser uma intervenção eficaz na recuperação da QVRS após a cirurgia em pacientes com cancro do pulmão, não havendo evidência do seu efeito benéfico em pacientes com CCR.N/

No Evidence for Lower Levels of Serum Vitamin D in the Presence of Hepatic Steatosis. A Study on the Portuguese General Population

Introduction and aims: Nonalcoholic fatty liver disease (NAFLD) has become highly prevalent, paralleling the pandemic of obesity and diabetes, and represents an important burden. Nutrition knowledge is fundamental, in prevention, evolution and treatment of NAFLD. Association of low serum levels of vitamin D (VD) with several diseases, including NAFLD, has been emphasized in the last decade. We evaluated how serum levels of VD correlate with the presence of hepatic steatosis, and VD intake, in a random sample of the Portuguese adult population. Methods: Participants underwent a dietary intake inquiry, using a semi-quantitative food frequency questionnaire representative of the usual intake over the previous year. Anthropometric measures, blood tests and ultrasound were done. Hepatic steatosis was quantified according to Hamaguchi's ultrasonographic score (steatosis defined by a score ≥ 2). Results: We recruited 789 adult individuals, 416 males (52.7%), mean age of 49.9 ± 17.0 years (18-79). Prevalence of hepatic steatosis was 35.5%, and after exclusion of excessive alcohol consumption, 28.0%. Mean VD serum levels were 26.0 ± 9.8 ng/ml and 68.4% participants had serum VD levels below 30 ng/ml. Mean serum levels of VD were not significantly different between participants with steatosis vs. no steatosis: 25.2±8.7 vs. 26.4±10.3 ng/ml, respectively (p=0.071). There was no correlation between VD serum levels and VD intake, measured by the FFQ, r=0.075 (p= 0.383). Conclusions: In spite of a high prevalence rate, there was no evidence that decreased VD serum levels were associated with hepatic steatosis. No significant correlation was found between VD dietary ingestion and VD serum levels.The present study received grants from: Portuguese Association for the Study of the Liver (APEF); Gilead Foundation and Gilead Genesis; and Roche supplied laboratorial kitsinfo:eu-repo/semantics/publishedVersio

ASO Visual Abstract: Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial

info:eu-repo/semantics/publishedVersio