Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities

Chronic obstructive pulmonary disease (COPD) and lung cancer are major lung diseases affecting millions worldwide. Both diseases have links to cigarette smoking and exert a considerable societal burden. People suffering from COPD are at higher risk of developing lung cancer than those without, and are more susceptible to poor outcomes after diagnosis and treatment. Lung cancer and COPD are closely associated, possibly sharing common traits such as an underlying genetic predisposition, epithelial and endothelial cell plasticity, dysfunctional inflammatory mechanisms including the deposition of excessive extracellular matrix, angiogenesis, susceptibility to DNA damage and cellular mutagenesis. In fact, COPD could be the driving factor for lung cancer, providing a conducive environment that propagates its evolution. In the early stages of smoking, body defences provide a combative immune/oxidative response and DNA repair mechanisms are likely to subdue these changes to a certain extent; however, in patients with COPD with lung cancer the consequences could be devastating, potentially contributing to slower postoperative recovery after lung resection and increased resistance to radiotherapy and chemotherapy. Vital to the development of new-targeted therapies is an in-depth understanding of various molecular mechanisms that are associated with both pathologies. In this comprehensive review, we provide a detailed overview of possible underlying factors that link COPD and lung cancer, and current therapeutic advances from both human and preclinical animal models that can effectively mitigate this unholy relationship

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Evaluation of policies to promote physical activity in afterschool programs: Are we meeting current benchmarks?

Background. Policies now recommend afterschool programs (ASP, 3–6 pm) provide children a minimum amount of physical activity daily. We examined the extent to which children attending ASPs meet existing national and state-level policies that specify expected levels of physical activity (PA). Methods. Accelerometer-derived physical activity (light and moderate-to-vigorous, MVPA) of 253 children (5–13 years) was compared to policies that recommend varying amounts of PA children should achieve during an ASP. Results. The proportion of children achieving a policy ranged from 0.0% (California 60 min MVPA and North Carolina 20% of daily program time devoted to MVPA), 1.2% (California 30 min MVPA), to 48.2% (National Afterschool Association 30 min light plus MVPA). Random effects logistic models indicated boys (odds ratio [OR] range 2.0 to 6.27) and children from a minority background (Black/Hispanic, OR range 1.87 to 3.98) were more likely to achieve a recommended level of physical activity, in comparison to girls and White children. Neither age nor BMI were related to achieving a policy. Conclusions. The PA of children attending ASP falls below policy recommended levels; however, these policies were developed in absence of data on expected PA levels during ASPs. Thus, concerted effort towards building a stronger ASP evidence-base for policy refinement is required

Effect of Kinesio^® Taping on Ankle Complex Motion and Stiffness and Jump Landing Time to Stabilization in Female Ballet Dancers

Ankle sprain is the most commonly diagnosed injury experienced by ballet dancers with few studies investigating preventive support measures such as Kinesio taping. The need exists to examine the mechanical support characteristics of Kinesio taping and effect of application on ankle motion and performance. This may be important to understanding the mechanical mechanisms attributed to Kinesio ankle taping and justify its use in the prevention and treatment of jump landing injuries in ballet dancers. This study compared Kinesio taping with and without tension and no tape (control) on active and passive measures of ankle complex motion in healthy ballet dancers. A secondary objective was to examine the effect of Kinesio taping on balance using time to stabilization. Participants performed three ballet jumps with single-leg landings on a force plate across three ankle support conditions consisting of Kinesio taping, sham-Kinesio taping, and no tape. Sagittal and frontal plane motion and load-displacement of the ankle complex for each support condition were obtained using an ankle arthrometer. Kinesio taping with tension significantly restricted inversion-eversion rotation and increased inversion stiffness of the ankle complex (p < 0.05). No significant differences were found among the three ankle support conditions for jump landing time to stabilization (p > 0.05). Arthrometric results indicate Kinesio taping significantly restricted ankle complex motion in the frontal plane that is associated with lateral ankle sprain. Objective information on the nature of Kinesio taping support can assist sports medicine practitioners when recommending ankle support to athletes

Morphometric Study of the Equine Navicular Bone: Comparisons between Fore and Rear Limbs

Navicular bones collected from the four limbs of 95 sound horses were studied. The anatomic bases have been laid down about morphometry of the navicular bones and their variations according to limbs, after corrections have been made for morphologic type, gender, weight, size and age. All the dimensions of the navicular bone (except for the thickness) were larger in the fore limb. This phenomenon probably reflects an attempt to compensate for the greater forces exerted upon the fore limbs during exercise and at rest. Navicular bones collected from the four limbs of 61 sound horses were studied and the anatomic bases were described for histomorphometry of the fore and rear navicular bones. Fore navicular bones possess less cortical bone at the level of the articular surface, as well as at the level of the flexor surface and proximal border, but larger amounts of cancellous bone. Articular and flexor surface cortical bone show a larger porosity in the fore navicular bones and a larger amount of mineralized cartilage. The mineralized portion for distal impar- and collateral sesamoidean ligaments are also larger for the fore navicular bones. Two distinct zones are observed for the flexor surface cortex that have never been reported in the literature before: an external zone, which is mainly composed of poorly remodelled lamellar bone, arranged in a disto-proximal oblique direction, and an internal zone, which is mainly composed of secondary bone, with a latero-medial direction of Haversian canals. Bone architecture is discussed with regard to the mechanic load, encountered by the bone during locomotion