Management of advanced ovarian cancer in Leicester: The benefits of a paradigm shift in surgical approach.

AIM: Surgery for advanced ovarian cancer (AOC) has evolved over the past decade to ingeminate the need to offer maximum effort surgery (MES). The aim of this study is to analyze the implementation of a paradigm shift in the surgical management of women with AOC at the University Hospitals of Leicester NHS Trust (UHL) in 2015, until 2020, compared to 2011-2014. METHODS: Retrospective cohort study of women with AOC who underwent cytoreductive surgery (CRS) in the UHL. The two groups were: 153 women from January 2011 to December 2014 (group 1), 136 women from January 2015 to January 2020 (group 2). RESULTS: In group 1, the 1, 3, and 5 years overall survival rates (OS) were, 90.4%, 33.7%, and 19.3%, compared to 90.2%, 55.4%, and 29.7%, respectively, in group 2 (p = 0.012). Significantly more women had CRS in group 2: 45-Primary debulking surgery (PDS) and 57-interval debulking surgery (IDS) versus 17-PDS & 67-IDS in group 1 (p < 0.001). Surgical complexity score (modified Aletti score) was higher in group 2 compared to group 1 (p = <0.001). No significant difference was noted in the postoperative complications, in group 2, in women who underwent PDS versus IDS, yet PDS was associated with higher OS. CONCLUSIONS: MES/CRS in women with AOC significantly improves OS. Our data highlights the importance of a dedicated team to implement this change in cancer centers. Where possible, suitable women with AOC likely to have complete cytoreduction based on preoperative assessment, should be offered PDS.

Analysis of the influential factors of maximal-effort expiratory capacity of elderly women.

[Purpose] The purpose of this study was to find the influential factors of maximal-effort expiratory capacity of elderly women. [Subjects and Methods] The subjects of this study were 83 healthy elderly women. The study's methods and purpose were explained and these women agreed to participate. The maximal-effort expiratory capacity was measured using spirometry (Pony FX, COSMED Inc., Italy). We measured forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity, maximal expiratory flow 75%, maximal expiratory flow 50%, and maximal expiratory flow 25%. [Results] Regarding forced vital capacity and forced expiratory volume in 1 second, it was found that height and age were influential factors. Regarding forced expiratory volume in 1 second/forced vital capacity %, maximal expiratory flow 75%, maximal expiratory flow 50%, and maximal expiratory flow 25%, it was found that only age was an influential factor. [Conclusion] This study demonstrated that the most influential factors of maximal-effort expiratory capacity of elderly women were age, and the second influential factor was height. We noticed that weight was the least influential factor among them.

Effects of heat exposure in the absence of hyperthermia on power output during repeated cycling sprints.

The aim of this study was to investigate the effects of heat exposure in the absence of hyperthermia on power output during repeated cycling sprints. Seven males performed four 10-s cycling sprints interspersed by 30 s of active recovery on a cycle ergometer in hot-dry and thermoneutral environments. Changes in rectal temperature were similar under the two ambient conditions. The mean 2-s power output over the 1st-4th sprints was significantly lower under the hot-dry condition than under the thermoneutral condition. The amplitude of the electromyogram was lower under the hot-dry condition than under the thermoneutral condition during the early phase (0-3 s) of each cycling sprint. No significant difference was observed for blood lactate concentration between the two ambient conditions. Power output at the onset of a cycling sprint during repeated cycling sprints is decreased due to heat exposure in the absence of hyperthermia.

Maximal Effort Cytoreduction in Epithelial Ovarian Cancer: Perioperative Complications and Survival Outcomes from a Retrospective Cohort.

Background: Rates of maximal effort cytoreductive surgery in ovarian cancer patients increase gradually the last decade. The purpose of the present study is to evaluate factors that contribute to survival and morbidity outcomes in this group of patients. Methods: We retrospectively reviewed patient records of epithelial ovarian cancer patients with an intermediate and high Mayo Clinic surgical complexity score, operated between January 2010 and December 2018. Results: Overall, 107 patients were enrolled in the present study with a median age of 62 years (23-84) and a follow-up of 32 months (2-156). Thirteen Clavien-Dindo grade IIIa complications were documented in 10 patients (9.3%). Of all the investigated factors, only stage IVb (p = 0.027) and interval debulking surgery (p = 0.042) affected overall survival rates. Overall survival outcomes of patients operated on a primary setting started to differentiate compared to those that received neo-adjuvant chemotherapy after the 4th postoperative year. Conclusions: Maximal effort cytoreductive procedures should be considered feasible in the modern surgical era, as they are accompanied by acceptable rates of perioperative morbidity. Hence, every effort should be made to perform them in the primary setting, rather than following neoadjuvant chemotherapy as current evidence favor increased survival rates of patients that will likely surpass an interval of observation of more than 4 years.

Prediction of Maximum Lactate Concentration During an All-Out Anaerobic Test in Elite Ice Hockey Players.

The lack of specific on-ice tests to predict maximum lactate concentration limits the ability of coaches to better track and develop their ice hockey players. Thus, this study aimed to develop an equation for indirectly assessing the maximum lactate concentration produced from an all-out on-ice skating effort in elite adolescent ice hockey players. Twenty elite male ice hockey players participated in this study (age = 15.7 ± 1.0 year). The lactate anaerobic skating test (LAST) consisted of skating back and forth on an 18.2 m course at maximal speed with abrupt stops at each end for a total of 6 shuttles (total distance = 218.2 m; average time = 52.0 ± 2.0 s). The oxygen uptake was measured using a portable metabolic analyzer (Cosmed K4b2) and the maximum post-exercise lactate concentration with a Lactate Pro analyzer. The variables used to estimate lactate concentration were time, heart rate, number of skating strides in the last shuffle (6th) and the skating stride index. The average maximum lactate concentration was 14.4 mmol· L-1, which is expected in elite players. The analysis of explained common variance using T-test (r2 = 0.759) and linear regression (r2 = 0.863) demonstrates the validity of the model. Additionally, the root mean square error (RMSE = 0.60 mmol· L-1), the mean absolute error (MAE = 0.45mmol· L-1) and the standard error of estimate (SEE = 0.69 mmol· L-1) values further confirm the accuracy of the model. Thus, using simple and easy-to-measure variables (i.e., time and skating stride), coaches will be able to monitor more effectively their players' progress in an effort to optimize their individual on-ice performance.

Feasibility of the A-STEP for the assessment of exercise capacity in people with cystic fibrosis.

OBJECTIVES: To evaluate feasibility of the Alfred Step Test Exercise Protocol (A-STEP) for the assessment of exercise capacity in adults and children with cystic fibrosis (CF); in adults to test whether demographics and/or lung function correlated with exercise capacity. METHODS: Adults and children with stable CF from two centres completed the A-STEP (a recently developed incremental maximal-effort step test). Feasibility was evaluated by: usefulness for exercise capacity assessment (measures of exercise capacity were: level reached, exercise-induced desaturation, and achievement of at least one maximal effort criteria); safety; operational factors; time to complete; floor and/or ceiling effects. We used multiple linear regression to test whether demographics and/or lung function correlated with exercise capacity. RESULTS: A total of 49 participants: 38 adults (18 male), percent predicted (pp) forced expiration in one second (FEV1 ) 29-109, aged 22-48 years and 11 children (6 male), ppFEV1 68-107, aged 10-15 years were included. Levels reached (mean (SD) [range]) were 10.2 (2.4) [6-15] (adults), 10.1 (2.5) [7-14] (children); desaturation (change between baseline and peak-exercise SpO2 ): was 8.4 (3.8 [0-15]% (adults), 2.0 (2.0) [0-7]% (children). A total of 8 (21%) adults and no children desaturated <90% SpO2 . At least one criterion for maximal effort was reached by 33 (84%) adults and 10 (91%) children. There were no adverse events. The A-STEP was straightforward to use and carried out by one operator. A total of 26 (68.4%) adults and 7 (63.6%) children completed the test within the recommended 8-12 min. All participants completed a minimum of 6 levels, and completed the test before the final 16th level. In adults, ppFEV1 and ppFVC correlated with the level reached (r = 0.55; p = <0.001 and r = 0.66, p = <0.0001) and desaturation (r = 0.55, p = <0.001 and r = 0.45, p = <0.005). CONCLUSION: In adults and children with stable CF, the A-STEP was feasible, safe, and operationally easy to use for the assessment of exercise capacity, without floor or ceiling effects. In adults, lung function correlated with exercise capacity.

Adapted Chester Step Test Can Have Maximal Response Characteristics for the Assessment of Exercise Capacity in Young Women.

Chester step test (CST) estimates the exercise capacity through a submaximal response, which can limit its application in the prescription of exercise. This study aimed to assess whether an adaptation of the CST (with a progressive profile) can have maximal response characteristics in young women and compare it to the incremental shuttle walk test (ISWT). Another aim was to determine its within-day test-retest reliability. A cross-sectional study was conducted with 25 women (20.3 ± 1.5 years) who performed the field tests twice on two different days (48 h apart). The maximal effort attainment was assessed by the heart rate (HR), perception of exertion (Borg scale), and blood lactate concentration. For the performance variables, Pearson's correlation and intraclass correlation coefficient (ICC2,1) were used. In the best test, mean values of maximal response were observed in the adapted CST (94.0 ± 6.5% of age-predicted HRmax, 11.3 ± 4.5 mmol/dl of blood lactate, and 18.4 ± 1.5 of Borg rating). The correlations between the adapted CST and the ISWT were weak to moderate (0.38 ≤ r ≤ 0.55; p < 0.05). Fair to good reliability was found for the adapted CST (ICC2,1 = 0.48-0.61). The adapted CST showed mean values of maximal response, weak to moderate association with the ISWT, and low within-day test-retest reliability in young women.

Identifying sincerity of effort by grip strength ratio of three wrist positions in individuals with upper extremity musculoskeletal disorders.

OBJECTIVES: To evaluate whether the grip strength ratio of three wrist positions could determine sincerity of effort (SOE), by differentiating between maximal effort (ME) and submaximal effort (SE), in individuals with upper extremity musculoskeletal disorders (MSDs). METHODS: A total of 19 volunteers with unilateral upper extremity MSDs (9 males, 10 females) participated in this study. Participants performed grip strength tests in neutral, full flexion, and full extension wrist positions for both hands. In each wrist position, they exerted grip force with their ME and preferred SE for three times. RESULTS: Significant main effects of type of effort, wrist position (P < .001), and hand (P = .005) were observed. The results also showed significant interactions for type of effort × wrist position (P < .001) and wrist positions × hand (P = .001). Moreover, the grip strength ratios of neutral/flexion (N/F) and neutral/extension (N/E) between ME and SE differed significantly (P < .001). CONCLUSION: This study suggests that the N/F and N/E grip strength ratios can discriminate between ME and SE in individuals with upper extremity MSDs. Thus, this test might be applicable to use for identifying SOE in clinical setting.

Normative Static Grip Strength of Saudi Arabia's Population and Influences of Numerous Factors on Grip Strength.

Most daily tasks require exerting static grip strength which can be challenging for the elderly as their strength diminishes with age. Moreover, normative static grip strength data are important in ergonomics and clinical settings. The goal of this study is to present the gender, age-specific, hand-specific, and body-mass-index-specific handgrip strength reference of Saudi males and females in order to describe the population's occupational demand and to compare them with the international standards. The secondary objective is to investigate the effects of gender, age group, hand area, and body mass index on the grip strength. A sample of 297 (146 male and 151 female) volunteers aged between 18 and 70 with different occupations participated in the study. Grip strength data were collected using a Jamar dynamometer with standard test position, protocol, and instructions. The mean maximum voluntary grip strength values for males were 38.71 kg and 22.01 kg, respectively. There was a curvilinear relationship of grip strength to age; significant differences between genders, hand area, and some age groups; and a correlation to hand dimensions depending on the gender.

Comparison of Selected CD45+ Cell Subsets' Response and Cytokine Levels on Exhaustive Effort Among Soccer Players.

BACKGROUND: Immunological alterations may led to the reduction in capacity and endurance levels in elite athletes by e.g. increased susceptibility to infections. There is a need to explain the impact of intensive physical effort on the CD4+ memory T cell subsets. METHODS: Fourteen participants median aged 19 years old (range 17-21 years) were recruited form Pogon Szczecin S.A., soccer club. They performed progressive efficiency test on mechanical treadmill until exhaustion twice: during preparatory phases to spring and autumn competition rounds. We examined the influence of exhaustive effort on the selected CD45+, especially CD4+ memory T cell subsets and inflammation markers determined before, just after the test and during recovery time. RESULTS: Significant changes in total CD45+ cells and decrease in T lymphocytes percentage after the run was observed. Significant fluctuations in T cells' distribution were related not only to the changes in Th or Tc subsets but also to increase in naïve T cell percentage during recovery. Increase in TNF-α and IL-8 post-exercise, IL-6 and IL-10 plasma levels in recovery was also found. CONCLUSIONS: The novel finding of our study is that the run performed on mechanical treadmill caused a significant release of CD4+ T naïve cells into circulation. Post-exercise increase in circulating NK cells is related with fast biological response to maximal effort. However, at the same time an alternative mechanism enhancing inflammation is involved.

Determining Sincerity of Effort Based on Grip Strength Test in Three Wrist Positions.

BACKGROUND: Several grip strength tests are commonly used for detecting sincerity of effort. However, there is still no widely accepted standardized sincerity of effort test. Therefore, this study aimed to examine whether grip strength test in three wrist positions could distinguish between maximal and submaximal efforts. METHODS: Twenty healthy individuals (10 men and 10 women) with a mean age of 26.7 ± 3.92 years participated in this study. All participants completed two test conditions (maximal and submaximal efforts) in three wrist positions (neutral, flexion, and extension) using both hands. Each participant exerted 100% effort in the maximal effort condition and 50% effort in the submaximal effort condition. The participants performed three repetitions of the grip strength test for each session. RESULTS: The results showed that there is a significant main effect of the type of effort (p < 0.001), wrist position (p < 0.001), and hand (p = 0.028). There were also significant types of effort and wrist position interactions (p < 0.001) and effort and hand interactions (p < 0.028). The results also showed that grip strength was highest at the wrist in neutral position in both the maximal and the submaximal effort condition. Grip strength values of the three wrist positions in the maximal effort condition were noticeably greater than those in the submaximal effort condition. CONCLUSION: The findings of this study suggest that grip strength test in three wrist positions can differentiate a maximal effort from a submaximal effort. Thus, this test could potentially be used to detect sincerity of effort in clinical setting.

The Effects of Industrial Protective Gloves and Hand Skin Temperatures on Hand Grip Strength and Discomfort Rating.

Daily working activities and functions require a high contribution of hand and forearm muscles in executing grip force. To study the effects of wearing different gloves on grip strength, under a variety of hand skin temperatures, an assessment of the maximum grip strength was performed with 32 healthy male workers with a mean age (standard deviation) of 30.44 (5.35) years wearing five industrial gloves at three hand skin temperatures. Their ages and anthropometric characteristics including body mass index (BMI), hand length, hand width, hand depth, hand palm, and wrist circumference were measured. The hand was exposed to different bath temperatures (5 °C, 25 °C, and 45 °C) and hand grip strength was measured using a Jamar hydraulic hand dynamometer with and without wearing the gloves (chemical protection glove, rubber insulating glove, anti-vibration impact glove, cotton yarn knitted glove, and RY-WG002 working glove). The data were analyzed using the Shapiro-Wilk test, Pearson correlation coefficient, Tukey test, and analysis of variance (ANOVA) of the within-subject design analysis. The results showed that wearing gloves significantly affected the maximum grip strength. Wearing the RY-WG002 working glove produced a greater reduction on the maximum grip when compared with the bare hand, while low temperatures (5 °C) had a significant influence on grip when compared to medium (25 °C) and high (45 °C) hand skin temperatures. In addition, participants felt more discomfort in both environmental extreme conditions. Furthermore, they reported more discomfort while wearing neoprene, rubber, and RY-WG002 working gloves.

Repeated Dribbling Ability in Young Soccer Players: Reproducibility and Variation by the Competitive Level.

The intermittent nature of match performance in youth soccer supports relevance of ability to repeatedly produce high-intensity actions with short recovery periods. This study was aimed to examine the reproducibility of a repeated dribbling ability protocol and, additionally, to estimate the contribution of concurrent tests to explain inter-individual variability in repeated dribbling output. The total sample comprised 98 players who were assessed as two independent samples: 31 players were assessed twice to examine reliability of the protocol; and 67 juveniles aged 16.1 ± 0.6 years were compared by the competitive level (local, n = 34; national, n = 33) to examine construct validity. All single measurements appeared to be reasonably reliable: total (ICC = 0.924; 95%CI: 0.841 to 0.963); ideal (ICC = 0.913; 95%CI: 0.820 to 0.958); worst (ICC = 0.813; 95%CI: 0.611 to 0.910). In addition, the percentage of the coefficient of variation was below the critical value of 5% for total (%CV = 3.84; TEM = 2.51 s); ideal (%CV = 3.90, TEM = 2.48 s). Comparisons between local and national players suggested magnitude effects as follows: moderate (d-value ranged from 0.63 to 0.89) for all repeated sprint ability scores; large for total (d = 1.87), ideal (d = 1.72), worst (d = 1.28) and moderate for composite scores: the fatigue index (d = 0.69) and the decrement score (d = 0.67). In summary, the dribbling protocol presented reasonable reproducibility properties and output extracted from the protocol seemed to be independent from biological maturation.

The geometric curvature of the spine of runners during maximal incremental effort test.

This study sought to analyse the behaviour of the average spinal posture using a novel investigative procedure in a maximal incremental effort test performed on a treadmill. Spine motion was collected via stereo-photogrammetric analysis in thirteen amateur athletes. At each time percentage of the gait cycle, the reconstructed spine points were projected onto the sagittal and frontal planes of the trunk. On each plane, a polynomial was fitted to the data, and the two-dimensional geometric curvature along the longitudinal axis of the trunk was calculated to quantify the geometric shape of the spine. The average posture presented at the gait cycle defined the spine Neutral Curve. This method enabled the lateral deviations, lordosis, and kyphosis of the spine to be quantified noninvasively and in detail. The similarity between each two volunteers was a maximum of 19% on the sagittal plane and 13% on the frontal (p<0.01). The data collected in this study can be considered preliminary evidence that there are subject-specific characteristics in spinal curvatures during running. Changes induced by increases in speed were not sufficient for the Neutral Curve to lose its individual characteristics, instead behaving like a postural signature. The data showed the descriptive capability of a new method to analyse spinal postures during locomotion; however, additional studies, and with larger sample sizes, are necessary for extracting more general information from this novel methodology.

Mechanical and electromyographic responses during the 3-min all-out test in competitive cyclists.

While the 3-min all-out test is an ideal exercise paradigm to study muscle fatigue during dynamic whole-body exercise, so far it has been used mainly to provide insight into the bioenergetic determinants of performance. To shed some light into the development of peripheral muscle fatigue during the 3-min all-out test, we investigated the time course of muscle-fibre conduction velocity (MFCV). Twelve well-trained cyclists (23 ± 3 yrs) performed an incremental test, a 3-min all-out familiarization trial and a 3-min all-out test. Surface electromyographic signals were detected from the vastus lateralis muscle of the dominant limb. MFCV decreased with power output, though with a somewhat different time course, and the two parameters were strongly correlated (r = 0.87; P < 0.001). A modest decrease in MFCV (17.7 ± 4.8%), probably due to the endurance characteristics of the subjects, may help explain why a relatively high power output (79 ± 8% of the peak power output of the incremental test; 60 ± 14% of the difference between this peak value and the gas exchange threshold) was still maintained at the end of the test. These findings suggest that muscle fatigue substantially affects performance in the 3-min all-out test, expanding on the traditional bioenergetic explanation that performance is limited by rate and capacity of energy supply.

Age-Related Differences in Systolic Blood Pressure Recovery after a Maximal-Effort Exercise Test in Non-Athletic Adults.

The present study investigated the rate of systolic blood pressure recovery (SBPR) amongst three male age groups. Ninety-six apparently healthy, non-athletic adult males (48 young [23.91±4.58 years], 32 middle-aged [41.78±5.98 years] and 16 elderly [62.87±2.57 years]) participated in the study. Subjects performed a maximal-effort ergometer exercise test. Maximal oxygen uptake (VO2max) was measured during the exercise protocol; heart rate (HR) and SBP were measured before exercise (after 10 and 15 minutes of rest), during exercise (at 2-minute intervals), and at the first minute of post-exercise recovery and subsequently at 2-minute intervals until the recovery of SBP. Results showed that third-minute SBP ratio relative to 1 minute of recovery (SBPRy) was significantly lower (p<0.01; p<0.001) in the young (0.87± 0.06) when compared to middle aged (0.91 ± 0.05) and elderly adults (0.93 ± 0.04). Using bivariate correlation analysis, VO2max and %HR decline at 1 minute and 3 minutes of recovery, correlated with SBPRy in all age groups but after controlling for their confounders, only %HR decline in 3 min remained significantly correlated with SBPR in all the age groups. This study therefore showed age differences in SBPR after exercise with younger adults indicating faster recovery than older adults. After controlling for factors influencing SBPR, %HR decline in 3 min of recovery appeared to be a stronger contributor to age differences in SBPR than %HR decline in 1 min and VO2max. The reported data indicate the need to take age into account when interpreting SBPR after exercise during physical assessment of healthy individuals.