The effectiveness of prehabilitation interventions on biopsychosocial and service outcomes pre and post upper gastrointestinal surgery : a systematic review

Purpose. This review synthesised the evidence for the effect of prehabilitation interventions on biopsychosocial and service outcomes. Materials and Methods. A systematic review was conducted. 10 databases were searched to December 2023. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were included. Prehabilitation was any preoperative intervention to improve physical or psychological outcomes. Included studies required a comparator group or alternative preoperative intervention as well as baseline, presurgical and postoperative assessment points. Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). Results. 6028 studies were screened, with 25 studies included. Prehabilitation interventions were: inspiratory muscle training (five studies n = 450); exercise (nine studies n = 683); psychological (one study n = 400); and nutritional (ten studies n = 487). High quality studies showed preoperative improvements in impairments directly targeted by the interventions. Generally, these did not translate into functional or postoperative improvements, but multimodal interventions were more promising. Conclusion. Current evidence supports prehabilitation as safe to preserve or improve preoperative function. Heterogeneity in outcomes and variable study quality means definitive conclusions regarding interventions are not yet possible, limiting implementation. Agreement of clinical outcomes and cost effectiveness evaluation is required

Topological entropy of a stiff ring polymer and its connection to DNA knots

We discuss the entropy of a circular polymer under a topological constraint. We call it the {\it topological entropy} of the polymer, in short. A ring polymer does not change its topology (knot type) under any thermal fluctuations. Through numerical simulations using some knot invariants, we show that the topological entropy of a stiff ring polymer with a fixed knot is described by a scaling formula as a function of the thickness and length of the circular chain. The result is consistent with the viewpoint that for stiff polymers such as DNAs, the length and diameter of the chains should play a central role in their statistical and dynamical properties. Furthermore, we show that the new formula extends a known theoretical formula for DNA knots.Comment: 14pages,11figure

Osteonecrosis in children and young adults treated for acute lymphoblastic leukemia : a scoping review

Osteonecrosis (ON) is a common disabling complication of treatment for patients with acute lymphoblastic leukaemia (ALL). Reported incidence rates range from 1% to 61% and multiple possible risk factors have been identified. This review explored existing evidence to provide new perspectives and recommendations for future interdisciplinary research. PEDro, CINAHL, AMED, EMBSAE, OVID, EMCARE databases were systematically searched from their inception to March 2022. Published original research reporting the incidence rates of osteonecrosis in patients aged 10–25 with ALL were included. Study reporting quality was assessed against appropriate reporting guidelines (STROBE, CONSORT and CROSS). All relevant data reporting incidence rates and risk factors were extracted for narrative synthesis. 3146 report titles were screened, with 34 studies included (n = 12,056) (30 observational cohort studies, three randomised trials, and one questionnaire study). The median study quality reporting score was 68% (IQR 64–82%). Median overall incidence rate of ON was 51.8% (IQR 41.4–58.9%) and 15.65% (IQR 9.2–24.2%) for asymptomatic and symptomatic patient screening respectively. Five possible risk factor categories were identified: sex assigned at birth, age, ethnicity, steroid regimen, and genotype. The female sex and white ethnicity were consistently reported as risk factors independently associated with an increased risk of osteonecrosis in all studies. A heterogenous body of literature with moderate reporting quality identified a high incidence rate of osteonecrosis in patients with ALL. Future research investigating the efficacy of stratified treatments that focus on reducing the risk of osteonecrosis through modification of steroid regimen particularly in females of white ethnicity is needed. Obtaining multidisciplinary consensus with regards to screening methodologies and intervention outcomes may also help to improve evidence synthesis in this area. This may in turn facilitate early diagnosis and improve long term patient outcomes through treatment regimen modification and possible prevention of ON progression

From In Situ to satellite observations of pelagic Sargassum distribution and aggregation in the Tropical North Atlantic Ocean

International audienceThe present study reports on observations carried out in the Tropical North Atlantic in summer and autumn 2017, documenting Sargassum aggregations using both ship-deck observations and satellite sensor observations at three resolutions (MSI-10 m, OLCI-300 m, VIIRS-750 m and MODIS-1 km). Both datasets reported that in summer, Sargassum aggre-gations were mainly observed off Brazil and near the Caribbean Islands, while they accumulated near the African coast in autumn. Based on in situ observations, we propose a five-class typology allowing standardisation of the description of in situ Sargassum raft shapes and sizes. The most commonly observed Sargassum raft type was windrows, but large rafts composed of a quasi-circular patch hundreds of meters wide were also observed. Satellite imagery showed that these rafts formed larger Sargassum aggregations over a wide range of scales, with smaller aggregations (of tens of m 2 area) nested within larger ones (of hundreds of km 2). Match-ups between different satellite sensors and in situ observations were limited for this dataset, mainly because of high cloud cover during the periods of observation. Nevertheless, comparisons between the two datasets showed that satellite sensors successfully detected Sargassum abundance and aggregation patterns consistent with in situ observations. MODIS and VIIRS sensors were better suited to describing the Sargas-sum aggregation distribution and dynamics at Atlantic scale, while the new sensors, OLCI and MSI, proved their ability to detect Sargassum aggregations and to describe their (sub-) mesoscale nested structure. The high variability in raft shape, size, thickness, depth and biomass density observed in situ means that caution is called for when using satellite maps of Sargassum distribution and biomass estimation. Improvements would require additional in situ and airborne observations or very high-resolution satellite imagery

Analysis of sexual phenotype and prezygotic fertility in natural populations of Fucus spiralis, F. vesiculosus (Fucaceae, Phaeophyceae) and their putative hybrids

In the genus Fucus, the character dioecy/hermaphroditism has undergone multiple state changes and hybridization is possible between taxa with contrasting mating systems, e.g. between the dioecious Fucus vesiculosus and the hermaphrodite F. spiralis. In the context of mating system evolution, we evaluated the potential consequences of hybridization by studying the variation in sexual phenotype and prezygotic fertility. Firstly, as a result of hybridization between the two sexual systems, gender variation may arise depending on the relative importance of genes with large versus small phenotypic effects. We thus qualitatively examined the extent of gender variation within and among individual hybrids in comparison with both parental species. Secondly, if hybridization breaks up co-adapted gene complexes, hybrid fertility may be reduced in comparison with both parental species. Therefore, we also quantified male and female prezygotic fertility in parental species and their hybrids in order to test for reduction in hybrid fitness. A total of 89 sexually mature individuals (20 F. spiralis, 40 F. vesiculosus, 10 hermaphrodite hybrids and 19 dioecious hybrids) were sampled in two geographically distant regions (France and Portugal) and six conceptacles per individual were observed. Within-individual variation was very restricted qualitatively – only one hybrid carried a conceptacle with a different sexual phenotype from the five others – as well as quantitatively. This suggests a simple genetic system for sex determination involving a few genes with major effects. In addition, analyses showed no significant decrease in hybrid fertility compared with parental species. Moreover, hybrids exhibited all sexual phenotypes, suggesting several generations of hybridization and backcrossing and, therefore, that hybrids are reproductively successful. Finally, the occurrence of sterile paraphyses in female and hermaphrodite individuals was interpreted as a relic of male function and suggests that, as in higher plants, evolution from hermaphroditism to dioecy may be the most parsimonious pathway

Bone Mass and the CAG and GGN Androgen Receptor Polymorphisms in Young Men

BACKGROUND: To determine whether androgen receptor (AR) CAG (polyglutamine) and GGN (polyglycine) polymorphisms influence bone mineral density (BMD), osteocalcin and free serum testosterone concentration in young men. METHODOLOGY/PRINCIPAL FINDINGS: Whole body, lumbar spine and femoral bone mineral content (BMC) and BMD, Dual X-ray Absorptiometry (DXA), AR repeat polymorphisms (PCR), osteocalcin and free testosterone (ELISA) were determined in 282 healthy men (28.6+/-7.6 years). Individuals were grouped as CAG short (CAG(S)) if harboring repeat lengths of < or = 21 or CAG long (CAG(L)) if CAG > 21, and GGN was considered short (GGN(S)) or long (GGN(L)) if GGN < or = 23 or > 23. There was an inverse association between logarithm of CAG and GGN length and Ward's Triangle BMC (r = -0.15 and -0.15, P<0.05, age and height adjusted). No associations between CAG or GGN repeat length and regional BMC or BMD were observed after adjusting for age. Whole body and regional BMC and BMD values were similar in men harboring CAG(S), CAG(L), GGN(S) or GGN(L) AR repeat polymorphisms. Men harboring the combination CAG(L)+GGN(L) had 6.3 and 4.4% higher lumbar spine BMC and BMD than men with the haplotype CAG(S)+GGN(S) (both P<0.05). Femoral neck BMD was 4.8% higher in the CAG(S)+GGN(S) compared with the CAG(L)+GGN(S) men (P<0.05). CAG(S), CAG(L), GGN(S), GGN(L) men had similar osteocalcin concentration as well as the four CAG-GGN haplotypes studied. CONCLUSION: AR polymorphisms have an influence on BMC and BMD in healthy adult humans, which cannot be explained through effects in osteoblastic activity

Awareness and perceptions of a hospital\u27s closed-circuit TV channels.

Closed-circuit television (CCTV) programs are used in many hospitals for patient education and entertainment. However, few studies have addressed how patients perceive CCTV programs and whether the educational and entertainment objectives have been satisfied. We studied these questions by surveying patients from a major suburban teaching hospital. We found that when care providers recommended viewing, patients were more likely to watch and to perceive the programs as valuable