Virtual reality exercise intradialysis to improve physical function: A feasibility randomized trial

[EN] Objective The main objective of this investigation was to assess feasibility of conducting a future RCT with an intradialysis non-immersive virtual reality exercise intervention. The secondary aim was to explore the impact of either conventional or VR exercise on physical function. Design Feasibility randomized trial. Participants Eighteen subjects who participated in a 16-week intradialysis combined exercise program. Interventions The program lasted four additional weeks of either combined exercise or virtual reality exercise. Main outcome measures Physical function was measured through several reliable tests (sit-to-stand-to-sit tests 10 and 60, gait speed, one-leg heel-rise tests, and 6-minute walk test) at baseline, after 16 weeks of intradialysis combined exercise and by the end of four additional weeks of exercise. Adherence to the exercise programs was registered. Results There was a significant time effect, so that physical function improved in both groups. By the end of the 20 weeks, function improved as measured through the sit-to-stand-to-sit tests 10 and 60, gait speed, one-leg heel-rise left leg, and the 6-minute walk test. Changes that did not occur due to error in the test were seen after 20 weeks were achieved in the sit-to-stand-to-sit test 60, gait speed, one-leg heel-rise test for the left leg, and 6-minute walking test. Conclusion Virtual reality was a feasible intervention. Both interventions improved physical function. Adherence was not significantly different between groups.Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain, Grant/Award Number: Consolidacion de Indicadores CEU-UCH 2016-2017/ISegura-Orti, E.; Perez-Dominguez, B.; Ortega-Pérez De Villar, L.; Melendez-Oliva, E.; Martínez-Gramaje, J.; García-Maset, R.; Gil-Gómez, J. (2019). Virtual reality exercise intradialysis to improve physical function: A feasibility randomized trial. Scandinavian Journal of Medicine and Science in Sports. 29(1):89-94. https://doi.org/10.1111/sms.13304S8994291Segura-Ortí, E., Gordon, P. L., Doyle, J. W., & Johansen, K. L. (2017). Correlates of Physical Functioning and Performance Across the Spectrum of Kidney Function. Clinical Nursing Research, 27(5), 579-596. doi:10.1177/1054773816689282Segura-Orti, E., & Johansen, K. L. (2010). Exercise in End-Stage Renal Disease. Seminars in Dialysis, 23(4), 422-430. doi:10.1111/j.1525-139x.2010.00766.xDelgado, C., & Johansen, K. L. (2011). Barriers to exercise participation among dialysis patients. Nephrology Dialysis Transplantation, 27(3), 1152-1157. doi:10.1093/ndt/gfr404Heiwe, S., & Tollin, H. (2012). Patients’ perspectives on the implementation of intra-dialytic cycling—a phenomenographic study. Implementation Science, 7(1). doi:10.1186/1748-5908-7-68Konstantinidou, E., Koukouvou, G., Kouidi, E., Deligiannis, A., & Tourkantonis, A. (2002). Exercise training in patients with end-stage renal disease on hemodialysis: Comparison of three rehabilitation programs. Journal of Rehabilitation Medicine, 34(1), 40-45. doi:10.1080/165019702317242695Corbetta, D., Imeri, F., & Gatti, R. (2015). Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. Journal of Physiotherapy, 61(3), 117-124. doi:10.1016/j.jphys.2015.05.017Peruzzi, A., Cereatti, A., Della Croce, U., & Mirelman, A. (2016). Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: a pilot study. Multiple Sclerosis and Related Disorders, 5, 91-96. doi:10.1016/j.msard.2015.11.002Brien, M., & Sveistrup, H. (2011). An Intensive Virtual Reality Program Improves Functional Balance and Mobility of Adolescents With Cerebral Palsy. Pediatric Physical Therapy, 23(3), 258-266. doi:10.1097/pep.0b013e318227ca0fOrtega‐Pérez de VillarL Pérez‐ DomínguezB Segura‐OrtíE et al.Use of virtual reality game as part of exercise program for chronic kidney disease patients undergoing haemodialysis.2015.Cho, H., & Sohng, K.-Y. (2014). The Effect of a Virtual Reality Exercise Program on Physical Fitness, Body Composition, and Fatigue in Hemodialysis Patients. Journal of Physical Therapy Science, 26(10), 1661-1665. doi:10.1589/jpts.26.1661OrtegaL.Comparison of two exercise programs for hemodialysis patients intradialysis vs home based program. absolute and relative reliability of physical performance[tesis doctoral]. Universidad CEU Cardenal Herrera. Facultad de Ciencias de la Salud;2017.Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Salive, M. E., & Wallace, R. B. (1995). Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability. New England Journal of Medicine, 332(9), 556-562. doi:10.1056/nejm199503023320902Segura-Ortí, E., & Martínez-Olmos, F. J. (2011). Test-Retest Reliability and Minimal Detectable Change Scores for Sit-to-Stand-to-Sit Tests, the Six-Minute Walk Test, the One-Leg Heel-Rise Test, and Handgrip Strength in People Undergoing Hemodialysis. Physical Therapy, 91(8), 1244-1252. doi:10.2522/ptj.20100141Segura-Ortí, E. (2017). Fisioterapia sobre ejercicio en pacientes en hemodiálisis. Fisioterapia, 39(4), 137-139. doi:10.1016/j.ft.2017.05.003Bohm, C., Stewart, K., Onyskie-Marcus, J., Esliger, D., Kriellaars, D., & Rigatto, C. (2014). Effects of intradialytic cycling compared with pedometry on physical function in chronic outpatient hemodialysis: a prospective randomized trial. Nephrology Dialysis Transplantation, 29(10), 1947-1955. doi:10.1093/ndt/gfu248KOUFAKI, P., NASH, P. F., & MERCER, T. H. (2002). Assessing the efficacy of exercise training in patients with chronic disease. Medicine & Science in Sports & Exercise, 34(8), 1234-1241. doi:10.1097/00005768-200208000-00002Cappy, C. S., Jablonka, J., & Schroeder, E. T. (1999). The effects of exercise during hemodialysis on physical performance and nutrition assessment. Journal of Renal Nutrition, 9(2), 63-70. doi:10.1016/s1051-2276(99)90002-xHeadley, S., Germain, M., Mailloux, P., Mulhern, J., Ashworth, B., Burris, J., … Jones, M. (2002). Resistance training improves strength and functional measures in patients with end-stage renal disease. American Journal of Kidney Diseases, 40(2), 355-364. doi:10.1053/ajkd.2002.34520Painter, P., Carlson, L., Carey, S., Paul, S. M., & Myll, J. (2000). Low-functioning hemodialysis patients improve with exercise training. American Journal of Kidney Diseases, 36(3), 600-608. doi:10.1053/ajkd.2000.16200Segura-Ortí, E., Kouidi, E., & Lisón, J. F. (2009). Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clinical Nephrology, 71(05), 527-537. doi:10.5414/cnp71527Esteve Simó, V., Junqué, A., Fulquet, M., Duarte, V., Saurina, A., Pou, M., … Ramírez de Arellano, M. (2014). Complete Low-Intensity Endurance Training Programme in Haemodialysis Patients: Improving the Care of Renal Patients. Nephron Clinical Practice, 128(3-4), 387-393. doi:10.1159/000369253Johansen, K. L., Painter, P. L., Sakkas, G. K., Gordon, P., Doyle, J., & Shubert, T. (2006). Effects of Resistance Exercise Training and Nandrolone Decanoate on Body Composition and Muscle Function among Patients Who Receive Hemodialysis: A Randomized, Controlled Trial. Journal of the American Society of Nephrology, 17(8), 2307-2314. doi:10.1681/asn.2006010034Tao, X., Chow, S. K. Y., & Wong, F. K. (2017). The effects of a nurse-supervised home exercise programme on improving patients’ perceptions of the benefits and barriers to exercise: A randomised controlled trial. Journal of Clinical Nursing, 26(17-18), 2765-2775. doi:10.1111/jocn.13798Rossi, A. P., Burris, D. D., Lucas, F. L., Crocker, G. A., & Wasserman, J. C. (2014). Effects of a Renal Rehabilitation Exercise Program in Patients with CKD: A Randomized, Controlled Trial. Clinical Journal of the American Society of Nephrology, 9(12), 2052-2058. doi:10.2215/cjn.11791113Boone, A. E., Foreman, M. H., & Engsberg, J. R. (2017). Development of a novel virtual reality gait intervention. Gait & Posture, 52, 202-204. doi:10.1016/j.gaitpost.2016.11.025Orcy, R. B., Dias, P. S., Seus, T. L., Barcellos, F. C., & Bohlke, M. (2012). Combined Resistance and Aerobic Exercise is Better than Resistance Training Alone to Improve Functional Performance of Haemodialysis Patients - Results of a Randomized Controlled Trial. Physiotherapy Research International, 17(4), 235-243. doi:10.1002/pri.1526Oliveros R, M. S., Avendaño, M., Bunout, D., Hirsch, S., De La Maza, M. P., Pedreros, C., & Müller, H. (2011). Estudio piloto sobre entrenamiento físico durante hemodiálisis. Revista médica de Chile, 139(8), 1046-1053. doi:10.4067/s0034-98872011000800010Silva, S. F. da, Pereira, A. A., Silva, W. A. H. da, Simôes, R., & Barros Neto, J. de R. (2013). Physical therapy during hemodialyse in patients with chronic kidney disease. Jornal Brasileiro de Nefrologia, 35(3), 170-176. doi:10.5935/0101-2800.20130028Bulckaen, M., Capitanini, A., Lange, S., Caciula, A., Giuntoli, F., & Cupisti, A. (2011). Implementation of exercise training programs in a hemodialysis unit: effects on physical performance. Journal of Nephrology, 24(6), 790-797. doi:10.5301/jn.2011.6386Cook, S. A., MacLaughlin, H., & Macdougall, I. C. (2007). A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease. 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Test-retest reliability and minimal detectable change scores for the short physical performance battery, one-legged standing test and timed up and go test in patients undergoing hemodialysis

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients ( 0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.This project is supported by “Ayudas para la realización de proyectos de Investigación+Docencia en la CEU-UCH 2017-2018” code IDOC17/19 and we do not have a conflict of interest.https://doi.org/10.1371/journal.pone.020103513pubpub

DIVULGA.net: internacionalización de la divulgación del conocimiento científico y académico en internet

El proyecto DIVULGA.net tiene la finalidad específica de internacionalizar la difusión de conocimiento científico y académico, en una iniciativa liderada por alumnos UCM y cuyo propósito es incorporar a estudiantes de universidades extranjeras. De este modo se pueden crear sinergias que fortalezcan una red en internet de divulgación de cultura científica con los universitarios como agentes principales

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

EstuPlan: Methodology for the development of creativity in the resolution of scientific and social problems

[EN] Creative thinking is necessary to generate novel ideas and solve problems. "EstuPlan" is a methodology in which knowledge and creativity converge for the resolution of scientific problems with social projection. It is a training programme that integrates teachers, laboratory technicians and PhD students, master and undergraduate students which form working groups for the development of projects. Projects have a broad and essential scope and projection in terms of environmental problems, sustainable use of natural resources, food, health, biotechnology or biomedicine. The results show the success of this significant learning methodology using tools to develop creativity in responding to scientific and social demand for problem-solving to transfer academic knowledge to different professional environments. Bioplastics, Second Life of Coffee, LimBio, Algae oils, Ecomers, Caring for the life of your crop and Hate to Deforestate are currently being developed.Astudillo Calderón, S.; De Díez De La Torre, L.; García Companys, M.; Ortega Pérez, N.; Rodríguez Martínez, V.; Alzahrani, S.; Alonso Valenzuela, R.... (2019). EstuPlan: Methodology for the development of creativity in the resolution of scientific and social problems. En HEAD'19. 5th International Conference on Higher Education Advances. Editorial Universitat Politècnica de València. 711-717. https://doi.org/10.4995/HEAD19.2019.9205OCS71171

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Comparación de un programa de ejercicio intradiálisis frente a ejercicio domiciliario sobre capacidad física funcional y nivel de actividad física

Introducción: El ejercicio durante la hemodiálisis es beneficioso, aunque son pocas las unidades de hemodiálisis que ofrecen un programa de ejercicio adaptado a estos pacientes. Por ello es necesario encontrar alternativas más económicas para realizar ejercicio. El objetivo es comparar los efectos de un programa de ejercicio intradiálisis frente a ejercicio domiciliario, sobre la adherencia al programa, la capacidad física funcional y el nivel de actividad física. Métodos: 17 pacientes en hemodiálisis de un centro de Valencia fueron aleatorizados dividiéndoles en un grupo de ejercicio intradiálisis (n=9) y un grupo domiciliario (n=8). Ambos programas incluían ejercicio aeróbico y de fuerza durante 4 meses. Se valoró una amplia batería de pruebas funcionales (Short Physical Performance Battery, equilibrio monopodal, Timed Up and Go, Sit To Stand to sit test 10 y 60, dinamometría de mano, fuerza de tríceps, 6 minutos marcha) y dos cuestionarios de nivel de actividad física (Human Activity Profile y Physical Activity Scale for Elderly). Resultados: 2 pacientes del grupo intradiálisis y 5 pacientes de ejercicio domiciliario finalizaron el programa y fueron analizados. Se observó un efecto significativo del factor tiempo en el caso del Human Activity Profile (P<.017). En las pruebas funcionales no se encontró ninguna diferencia significativa. En cuanto a la adherencia al ejercicio los pacientes del grupo intradiálisis cumplieron el 92.7% y el grupo domiciliario el 68.7% del total de las sesiones. Conclusiones: En ambos grupos se observa un aumento del nivel de actividad física. Sin embargo, es necesario modificar factores, tanto en el personal sanitario como en los propios pacientes, para conseguir mayor adherencia a los programas de ejercicio

Cuantificación del deterioro funcional durante seis meses en pacientes en tratamiento renal sustitutivo con hemodiálisis

Introducción: Los pacientes en tratamiento de diálisis presentan una disminución de la función física, sin embargo, no hay estudios que demuestren el ritmo al que se produce este deterioro funcional. El objetivo principal es cuantificar el deterioro funcional de los pacientes en tratamiento de diálisis durante seis meses. Métodos: 43 pacientes en tratamiento de diálisis de dos centros de Valencia (España) (edad 61.3 +14.7 años) fueron analizados después de 6 meses. Los participantes completaron el Short Physical Performance Battery, equilibrio monopodal , el Timed Up and Go Test, Sit to stand to Sit Test 10 y 60, dinamometría de mano; elevación de talón y 6 minutos marcha. Además se recogieron datos de las historias clínicas y de las analíticas. Resultados: Tres de las pruebas mejoraron significativamente tras el periodo de 6 meses de observación: el Sit To Stand 10, la dinamometría de la mano derecha y la dinamometría de la mano izquierda, pero sin alcanzar un cambio clínico relevante. Por otro lado, otras medidas no obtuvieron un deterioro significativo como fueron el Short Physical Performance Battery, el Sit to Stand 60, la elevación del talón izquierdo y el 6 minutos marcha. Conclusiones: Después de 6 meses, en ninguna de las pruebas de capacidad funcional se observa un deterioro significativo. Se recomienda a los centros de hemodiálisis realizar un seguimiento de capacidad funcional anualmente, ya que con un periodo de 6 meses no se encuentran cambios significativos