Differential effects of long-term aerobic versus cognitively-engaging physical activity on children's visuospatial working memory related brain activation: A cluster RCT.

Different types of physical activity are thought to differentially affect children's brain activation, via physiological mechanisms, or by activating similar brain areas during physical and cognitive tasks. Despite many behavioral studies relying on these mechanisms, they have been rarely studied. This study looks at both mechanisms simultaneously, by examining effects of two physical activity interventions (aerobic vs. cognitively-engaging) on children's brain activation. Functional Magnetic Resonance Imaging (fMRI) data of 62 children (48.4% boys, mean age 9.2 years) was analyzed. Children's visuospatial working memory related brain activity patterns were tested using a Spatial Span Task before and after the 14-week interventions consisting of four physical education lessons per week. The control group followed their regular program of two lessons per week. Analyses of activation patterns in SPM 12.0 revealed no activation changes between pretest and posttest (p > .05), and no differences between the three conditions in pretest-posttest changes in brain activation (p > .05). Large inter-individual differences were found, suggesting that not every child benefited from the interventions in the same way. To get more insight into the assumed mechanisms, further research is needed to understand whether, when, for whom, and how physical activity results in changed brain activation patterns.

Relationships between gross motor skills, cardiovascular fitness, and visuospatial working memory-related brain activation in 8- to 10-year-old children.

Relationships between gross motor skills and cardiovascular fitness with visuospatial working memory (VSWM) in children are hypothesized to be mediated by underlying functional brain mechanisms. Because there is little experimental evidence to support this mechanism, the present study was designed to investigate the relationships of gross motor skills and cardiovascular fitness with VSWM-related brain activation in 8- to 10-year-old children. Functional magnetic resonance imaging data obtained during a VSWM-task were analyzed for 80 children from grades 3 (47.5%) and 4 of 21 primary schools in the Netherlands (51.3% girls). Gross motor skills (Korper Koordinationstest für Kinder and Bruininks-Oseretsky Test of Motor Proficiency - 2nd Edition) and cardiovascular fitness (20-meter Shuttle Run Test) were assessed. VSWM-related brain activation was found in a network involving the angular gyrus, the superior parietal cortex, and the thalamus; deactivation was found in the inferior and middle temporal gyri. Although behavioral results showed significant relations of gross motor skills and cardiovascular fitness with VSWM performance, gross motor skills and cardiovascular fitness were not related to VSWM-related brain activation. Therefore, we could not confirm the hypothesis that brain activation underlies the relationship of gross motor skills and cardiovascular fitness with VSWM performance. Our results suggest that either the effects of physical activity on cognition do not necessarily go via changes in gross motor skills and/or cardiovascular fitness, or that brain activation patterns as measured with the blood-oxygen-level dependent (BOLD) signal may not be the mechanism underlying the relationships of gross motor skills and cardiovascular fitness with VSWM.

Long-term follow-up of a multicentre cohort study on laparoscopic peritoneal lavage for perforated diverticulitis.

AIM: Laparoscopic peritoneal lavage has increasingly been investigated as a promising alternative to sigmoidectomy for perforated diverticulitis with purulent peritonitis. Most studies only reported outcomes up to 12 months. Therefore, the objective of this study was to evaluate long-term outcomes of patients treated with laparoscopic lavage. METHODS: Between 2008 and 2010, 38 patients treated with laparoscopic lavage for perforated diverticulitis in 10 Dutch teaching hospitals were included. Long-term follow-up data on patient outcomes, e.g. diverticulitis recurrence, reoperations and readmissions, were collected retrospectively. The characteristics of patients with recurrent diverticulitis or complications requiring surgery or leading to death, categorized as 'overall complicated outcome', were compared with patients who developed no complications or complications not requiring surgery. RESULTS: The median follow-up was 46 months (interquartile range 7-77), during which 17 episodes of recurrent diverticulitis (seven complicated) in 12 patients (32%) occurred. Twelve patients (32%) required additional surgery with a total of 29 procedures. Fifteen patients (39%) had a total of 50 readmissions. Of initially successfully treated patients (n = 31), 12 (31%) had recurrent diverticulitis or other complications. At 90 days, 32 (84%) patients were alive without undergoing a sigmoidectomy. However, seven (22%) of these patients eventually had a sigmoidectomy after 90 days. Diverticulitis-related events occurred up to 6 years after the index procedure. CONCLUSION: Long-term diverticulitis recurrence, re-intervention and readmission rates after laparoscopic lavage were high. A complicated outcome was also seen in patients who had initially been treated successfully with laparoscopic lavage with relevant events occurring up to 6 years after initial surgery.

Exploring the relations among physical fitness, executive functioning, and low academic achievement.

Physical fitness seems to be related to academic performance, at least when taking the role of executive functioning into account. This assumption is highly relevant for the vulnerable population of low academic achievers because their academic performance might benefit from enhanced physical fitness. The current study examined whether physical fitness and executive functioning are independent predictors of low mathematics and spelling achievement or whether the relation between physical fitness and low achievement is mediated by specific executive functions. In total, 477 students from second- and third-grade classes of 12 primary schools were classified as either low or average-to-high achievers in mathematics and spelling based on their scores on standardized achievement tests. Multilevel structural equation models were built with direct paths between physical fitness and academic achievement and added indirect paths via components of executive functioning: inhibition, verbal working memory, visuospatial working memory, and shifting. Physical fitness was only indirectly related to low achievement via specific executive functions, depending on the academic domain involved. Verbal working memory was a mediator between physical fitness and low achievement in both domains, whereas visuospatial working memory had a mediating role only in mathematics. Physical fitness interventions aiming to improve low academic achievement, thus, could potentially be successful. The mediating effect of executive functioning suggests that these improvements in academic achievement will be preceded by enhanced executive functions, either verbal working memory (in spelling) or both verbal and visuospatial working memory (in mathematics).

A multi-centred randomised trial of radical surgery versus adjuvant chemoradiotherapy after local excision for early rectal cancer.

BACKGROUND: Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5-20 %) suggesting that local excision alone is not sufficient, while completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients. METHODS/STUDY DESIGN: In this multicentre randomised trial, patients with an intermediate risk T1-2 rectal cancer, that has been locally excised using an endoluminal technique, will be randomized between adjuvant chemo-radiotherapylimited to the mesorectum and standard completion total mesorectal excision (TME). To strictly monitor the risk of locoregional recurrence in the experimental arm and enable early salvage surgery, there will be additional follow up with frequent MRI and endoscopy. The primary outcome of the study is three-year local recurrence rate. Secondary outcomes are morbidity, disease free and overall survival, stoma rate, functional outcomes, health related quality of life and costs. The design is a non inferiority study with a total sample size of 302 patients. DISCUSSION: The results of the TESAR trial will potentially demonstrate that adjuvant chemoradiotherapy is an oncological safe treatment option in patients who are confronted with the difficult clinical dilemma of a radically removed intermediate risk early rectal cancer by polypectomy or transanal surgery that is conventionally treated with subsequent radical surgery. Preserving the rectum using adjuvant radiotherapy is expected to significantly improve morbidity, function and quality of life if compared to completion TME surgery. TRIAL REGISTRATION: NCT02371304 , registration date: February 2015.

Long-term effects of physically active academic lessons on physical fitness and executive functions in primary school children.

Integrating physical activity into the curriculum has potential health and cognitive benefits in primary school children. The aim of this study was to investigate the effects of physically active academic lessons on cardiovascular fitness, muscular fitness and executive functions. In the current randomized controlled trial, 499 second and third graders within 12 primary schools (mean age = 8.1 ± 0.7) were randomized to the intervention (n = 249) or control condition (n = 250). The physically active academic lessons were given for 2 consecutive school years, 22 weeks per year, three times a week, with a duration of 20-30 min per lesson. Multiple tests were administered before, between and after the intervention period, measuring cardiovascular fitness, muscular fitness and executive functions. Multilevel analysis accounted for the nested structure of the children within classes and schools. Results showed a larger improvement in speed-coordination (B = -0.70,P = 0.002) and a lower improvement in static strength (B = -0.92,P < : 0.001) for the intervention group compared with the control group. The current lessons did not result in a significant change in executive functions.

Bridge-to-surgery stent placement versus emergency surgery for acute malignant colonic obstruction.

BACKGROUND: Endoscopic self-expanding metal stent (SEMS) placement as a bridge to surgery is an option for acute malignant colonic obstruction. There is ongoing debate regarding the superiority and oncological safety of SEMS placement compared with emergency surgery. This retrospective study aimed to compare outcomes of these treatment approaches. METHODS: Patients were identified from cohorts treated between 2005 and 2012 in two teaching hospitals, of which one used emergency surgery only in patients with large bowel obstruction, whereas the other attempted SEMS placement. Only patients treated with curative intent were included. RESULTS: The study included 59 patients in whom SEMS placement was attempted and 51 who underwent surgery alone. The successful primary anastomosis rate was higher in the SEMS group than in the surgery-alone group among patients with left-sided obstruction (30 of 43 versus 10 of 34 respectively; P = 0.001), whereas stoma formation was less common (11 of 43 versus 23 of 34; P < 0.001). Such differences were not apparent in patients with right-sided obstruction. Secondary stoma rates were comparable between treatment approaches (left-sided: 11 of 43 versus 13 of 34, P = 0.322; right-sided: 1 of 16 versus 1 of 17, P = 1.000). There were no significant differences in morbidity, mortality, recurrence or survival. CONCLUSION: Endoscopic SEMS placement increased the primary anastomosis rate in patients with left-sided large bowel obstruction.

Physical fitness and academic performance in primary school children with and without a social disadvantage.

This study examined the differences between children with a low socioeconomic status [socially disadvantaged children (SDC)] and children without this disadvantage (non-SDC) on physical fitness and academic performance. In addition, this study determined the association between physical fitness and academic performance, and investigated the possible moderator effect of SDC. Data on 544 children were collected and analysed (130 SDC, 414 non-SDC, mean age = 8.0 ± 0.7). Physical fitness was measured with tests for cardiovascular and muscular fitness. Academic performance was evaluated using scores on mathematics, spelling and reading. SDC did not differ on physical fitness, compared with non-SDC, but scored significantly lower on academic performance. In the total group, multilevel analysis showed positive associations between cardiovascular fitness and mathematics (ß = 0.23), and between cardiovascular fitness and spelling (ß = 0.16), but not with reading. No associations were found between muscular fitness and academic performance. A significant interaction effect between SDC and cardiovascular fitness was found for spelling. To conclude, results showed a specific link between cardiovascular fitness and mathematics, regardless of socioeconomic status. SDC did moderate the relationship between cardiovascular fitness and spelling.

Changes in patterns of peer relationships in primary education classroom networks through cooperative learning.

We studied the impact of cooperative learning on positive peer relationships, that is, liking to work together, in classroom networks. Cooperative learning was implemented as part of the "Success for All" program. Longitudinal social network analysis was used to investigate the development of structures and patterns of relationships in 16 intervention and 16 control classrooms, including a total of 791 students. Results showed significantly less reciprocation and transitivity in the dynamics of the intervention networks, while the number of nominations in the intervention classes was at least not smaller than in the control classes, indicating less tendency toward the formation of small clusters or cliques. We did not find that peer relationships became more diverse with regard to gender, socioeconomic status, or academic performance through the implementation of cooperative learning. In intervention classrooms, children tended to nominate their teammates with whom they work together in cooperative learning activities; however, also in control classrooms, children tended to nominate children with whom they are seated in the classroom. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Management of colovesical fistulae caused by diverticulitis: 12 years of experience in one medical centre.

BACKGROUND: Diverticulitis can be complicated by a colovesical fistula (CVF). This phenomenon is relatively uncommon in surgical practice. The aim of this study was to evaluate diagnostic and surgical management of CVF at our medical centre. MATERIAL AND METHODS: In this retrospective study, details of 31 patients undergoing surgery for CVF between January 1998 and March 2010 were recorded. These patient records were analysed for presenting symptoms, diagnostic investigations and surgical procedures. RESULTS: The most common presenting symptoms were pneumaturia, urinary tract infections, abdominal pain, and fecaluria. CT identified CVF in 28 patients (92.2%), cystoscopy in 4 patients (23.5%), and barium enema in 3 patients (13.6%). Surgical management was resection of the diseased colon segment with primary anastomosis in 29 of 31 patients. The bladder fistulae were oversewn and an omental plasty was placed between bowel anastomosis and bladder. There was only one postoperative leak and one case of mortality (3.2%). CONCLUSIONS: CT is the most sensitive test in identifying CVF. Resection of the diseased colon segment and primary anastomosis seems to be an effective and safe surgical method for treating CVF. This surgical treatment has an acceptable risk for anastomotic leak and mortality.

[The use of a self-expanding stent as palliation or before elective surgery in patients with obstructive colorectal carcinoma]. / Zelfexpanderende stent bij obstruerend colorectaal carcinoom als palliatie of als overbrugging naar electieve chirurgie.

OBJECTIVE: To evaluate the use of colorectal stents. DESIGN: Retrospective. METHOD: Data were collected on all patients treated at the Deventer Hospital, the Netherlands, between 1 April 1996 and 31 December 2003 in whom the placement of a self-expanding colorectal stent was attempted. Each patient's physician was contacted to inquire about the patient's status, including quality of life with the stent in situ. RESULTS: Stent placement was attempted in 57 patients as palliation (n = 45) or before elective surgery (n = 12). Of the 57 patients, 29 were men and 28 were women, and the mean age was 71 years (range: 46-94). All patients had colorectal carcinoma, except 1 patient with stenosis following ischaemic colitis. Passage of air and faeces occurred immediately after stent expansion in 55 of the 57 patients (96%). Perforation during stent placement occurred in 2 patients, who subsequently underwent colostomy. 4 additional patients required a colostomy due to stent migration within a few hours or days after placement (n = 3) or obstruction by tumor growth after 65 days (n = 1). Patients in the palliative group had an acceptable quality of life. Those who received a stent before elective surgery were able to undergo resection, did not require colostomy, and had no postoperative complications. One patient did not undergo surgery because of extensive metastases. CONCLUSION: A colorectal stent can be used in the palliative treatment of terminal patients with colorectal carcinoma before colostomy is considered. Experiences with stents before elective surgery were also positive.

Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process.