Cardiovascular responses during rest-exercise and exercise-exercise transients

If indeed vagal withdrawal determines the rapid response to exercise (phase I), the a large reduction, if not complete suppression, of phase I should be found, when an exercise transient starts from a previous lower steady state exercise rather than from rest. On 15 healthy young subjects we measured beat-by-beat cardiac output (Q̇, Modelflow from Portapres data) and heart rate (fH, ECG) during these cycle ergometer exercise transients: 0–50 W (transient from rest, RT) and 50–100W (transient from exercise, ET). A double exponential was used to compute amplitudes and time constants of phase I and II (A1 and A2; T1 and T2). At steady state, fH was 87.510.4, 109.312.0, and 139.617.1bpm, and Q̇ was 7.31.5, 12.61.6, and 16,11,9L/min, at rest, 50W and 100W, respectively. In RT, A1 and A2 for fH were 11.78.6 and 11.34.7bpm; the corresponding T1 and T2 were 1.61.9 and 14.421.3s. For Q̇, we had: A1=4.01.8L/min, A2=1.51.4L/min, T1=3.21.8s, T2=11.312.2s. In ET, the double exponential model provided preposterous A1 and T1 values and extremely high T2 values (>100s). Subsequent use of a mono exponential model provided, for fH, A=29.78.9bpm and T=7.74.9s, and for Q̇, A=3.58.6L/min, and T=7.05.7s. The A and T in ET did not differ from the A2 and T2 of RT. We conclude that a single exponential model is more adequate to describe ET and this single exponential corresponds to the second exponential of RT. Our results are compatible with the vagal withdrawal hypothesis

LIFESTYLE ASSESSMENT AND IMPROVEMENT WITH FOCUS ON LEISURE TIME PHYSICAL ACTIVITY AMONG UNIVERSITY STUDENTS: THE #STUDIOXLAVITA PROJECT

INTRODUCTION: Sedentariness, smoking, alcohol abuse and unbalanced feeding are harmful for health, leading to chronic diseases and increasing mortality rate. For young adults, University is a new social and cultural context: parents’ imprinting could be easily altered, new lifestyles take shape and personal choices emerge. Intervention programmes to advance awareness on harmful lifestyle and promote healthy habits are essential. The #studioxlavita project, launched in 2016 by the University of Brescia with these purposes, investigated students’ lifestyle, with special emphasis on physical activity . METHODS: We developed two consecutive facultative surveys, of 15 <1st level> and 52 items <2nd level>, addressed to all the University’s students. Questions were about leisure time physical activity , use of fitness technology, relationship with friends, classmates and parents, feed, physical appearance, body self-perception, physical and mental health, use of certain substances or products , night-time rest and beliefs concerning healthy behaviours. In the 2nd level survey we also adopted the Kessler Psychological Distress Scale and the short form of the International Physical Activity Questionnaire to estimate the amount of PA carried out in the last 7 days. Students who filled in both questionnaires received a personal report including the aggregate data analysis, a comparison with other investigations and indications about healthy habits, according to recommendations and guidelines. RESULTS: 3,436 out of 15,688 students filled in the1st level survey. Of them, 778 accepted to participate in the 2nd level survey, and 456 completed it. 1st level survey revealed that 72% of the students practised LTPA <45% regularly and 27% occasionally>. LTPA is largely performed <44% of the student> in non-competitive form, with recreational and/or health purposes. According to IPAQ-SF categorical score, 24%, 34% and 42% of the students performed low, moderate and high levels of PA, respectively. In 2st level survey, 76% of the students wished to practise more PA; 42% would participate in practical sport courses. CONCLUSION: University is an ideal setting for promoting lifestyle change among a captive audience. Intervention programs to increment PA are acclaimed by students. The students from University of Brescia reported higher LTPA practice than the national average people between 18 and 34 years <47%, data from Italian National Institute of Statistics, 2015>, although this parameter was assessed with different methods

EFFECTS OF PHYSICAL ACTIVITY PROMOTION AMONG UNIVERSITY STUDENTS: THE #STUDIOXLAVITA PROJECT

INTRODUCTION: Sedentariness is a major health problem in our time and physical activity promotion is an imperative commitment for healthcare systems. Recommendations from WHO indicate a minimum of 150 minutes of moderate intensity aerobic exercise as weekly standard for adults. Strategies to increment PA practice are implemented in different settings, such as house care, school, University and workplace. The project #studioxlavita <#SXLV> was launched by the University of Brescia in 2016 with the aim of collecting data about undergraduates lifestyle and encourage healthy behaviours. In particular we focused on PA assessment and promotion in a Universitybased setting. METHODS: Two consecutive surveys were sent to all students . Q0 included the short form of the International Physical Activity Questionnaire , the Kessler Psychological Distress Scale and additional questions on several lifestyle aspects. Among responders, we selected 40 students who agreed to take part in one of the following 15-week practical sport courses: ultimate frisbee, muscle strengthening and dance fitness. Before and after being engaged in practical sport courses, students underwent cardiopulmonary exercise test and skinfold thickness measurements, in order to assess peak oxygen consumption and percent body fat . Finally, to assess possible lifestyle changes, we sent them additional surveys at the end of the practical sport courses and 30 days after . Paired t-test was used to analyse significant differences. RESULTS: 27 students <16 female, 11 male; age: 22.7±3.7> concluded sport activity courses and filled in Q1. Of them, 20 completed also Q2. Overall courses attendance was 57%. At T1 , normalized Q̇O2peak increased with respect to T0 <37.0±6.9 vs 35.2±7.4 ml/min/Kg, p=0.03>. Conversely, percent body fat decreased <16.5±6.4 vs 18.3±7.5, p=0.01>. In Q1, 20 students declared to have a more active lifestyle since the beginning of the courses. In Q2, IPAQ-SF-derived total weekly energy expenditure was higher than in Q0, although not significant <5,839 ±7,035 MET*min vs 2,770±2,457 MET*min, p=0.1>. Q2 showed a reduced K6 scale score with respect to Q0 <13.8±4.6 vs 15.8±4.9, p=0.03>. CONCLUSION: With the sport activity courses established in #SXLV we gave students the opportunity to comply with WHO recommendations. After courses, they appeared to practice more PA, have a higher maximal aerobic capacity, a lower percent body fat and a lower grade of psychological distress than before courses. Simple activities as those proposed by #SXLV are sufficient to reduce sedentariness and improve the quality of life of student

Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study

Objectives: To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. Materials and methods: Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: “intratumoral” when 0 mm or negative, “close” when greater than 0 mm and less than or equal to 5 mm, “adequate” when greater than 5 mm and less than or equal to 15 mm, and “excessive” over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. Results: The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). Conclusion: This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting – with rigorous assessment of oncological outcomes – would be the proposed next step

Treatment of loco-regional recurrence of nasopharyngeal carcinoma in a non-endemic area: oncologic outcomes, morbidity, and proposal of a prognostic nomogram

Introduction: The study assessed outcomes and toxicities of different treatment modalities for local and/or regional recurrent nasopharyngeal carcinoma (NPC) in a non-endemic area. Methods: Patients treated with curative intent for recurrent NPC with salvage surgery, photon-based radiotherapy, proton therapy (PT), with or without chemotherapy, at different Italian referral centers between 1998 and 2020 were included. Adverse events and complications were classified according to the Common Terminology Criteria for Adverse Events. Characteristics of the patients, tumors, treatments, and complications are presented along with uni- and multivariate analysis of prognostic factors. A survival predictive nomogram is also provided. Results: A total of 140 patients treated from 1998 to 2020 were retrospectively assessed. Cases with lower age, comorbidity rate, stage, and shorter disease-free interval (DFI) preferentially underwent endoscopic surgery. More advanced cases underwent re-irradiation, fairly distributed between photon-based radiotherapy and PT. Age and DFI were independent factors influencing overall survival. No independent prognostic effect of treatment modality was observed. No significant difference in the morbidity profile of treatments was observed, with 40% of patients experiencing at least one adverse event classified as G3 or higher. Conclusion: Recurrent NPC in a non-endemic area has dissimilar aspects compared to its endemic counterpart, suggesting the need for further studies that can guide the choice of the best treatment modality

How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group

Purpose: In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. Methods: In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. Results: Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. Conclusions: The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology

Sinonasal squamous cell carcinoma, a narrative reappraisal of the current evidence

Sinonasal squamous cell carcinoma is a rare tumor affecting the nasal cavity and paranasal sinuses. Several aspects of this disease, ranging from epidemiology to biology, pathology, diagnosis, staging, treatment, and post-treatment surveillance are controversial, and consensus on how to manage this sinonasal cancer is lacking. A narrative literature review was performed to summarize the current evidence and provide the reader with available data supporting the decision-making process in patients affected by sinonasal squamous cell carcinoma, alongside the authors’ personal opinion on the unsolved issues of this tumor. The review has highlighted several advances in molecular definition of epithelial cancers of the sinonasal tract. Surgery represents the pivot of treatment and is performed through an endoscopic transnasal approach whenever feasible. Open surgery is required for a large proportion of cases. Reconstruction of the defect follows principles of skull base and cranio-maxillo-facial reconstruction. Chemotherapy is given as neoadjuvant treatment or concomitantly to radiotherapy. Photon-based radiation therapy has a crucial role in the adjuvant setting. Particle therapy is providing promising results. Management of the neck should be planned based on the presence of clinically appreciable metastases, primary tumor extension, and need for recipient vessels. Biotherapy and immunotherapy are still underexplored therapeutical modalities

Cardiovascular kinetics during moderate-intensity arm and leg exercise: a preliminary report

The phase I cardiovascular response to exercise implies an instantaneous cardiac output (Q̇) increase, due to the effect of sudden vagal withdrawal on heart rate (fH) and of sudden venous return increase, due to muscle pump action, on stroke volume (SV). If the latter is the case, we would expect that, when exercise is performed with small active muscle mass, the cardiovascular responses at exercise are depressed. On 8 healthy young subjects, we measured beat-by-beat fH, SV and Q̇ during arm ergometer and cycle ergometer exercise transitions, from rest to 50W. A double exponential model was applied to the transient phase, and we computed amplitudes and time constants of phase I (A1 and T1). For arm cranking, steady state fH was 65.27, and 102.37.8 bpm, at rest and 50 W exercise, respectively; corresponding SV was 106.116.5, and 112.913.4 mL, so that Q̇ was 6.60.8, and 11.81,4 L/min. For leg cycling, fH was 68.47.8, and 92.76 bpm, SV was 101.814.4, and 117.116 mL, and Q̇ was 6.90.6, and 10.81.2 L/min, at rest and exercise, respectively. For fH, A1 and T1, for arm exercise (18.48.1 bpm and 7.55 s, respectively) were greater (p&lt;.05) than the corresponding values for leg exercise (9.12.2 bpm and 3.22 s, respectively). No significant differences appeared in A1 and T1 for SV and Q̇ between the two exercise types. Exercises with different muscle masses acted on the kinetics of fH, but not on that of SV, and thus essentially on the vagal withdrawal mechanis