PUREAIR protocol: randomized controlled trial of intensive pulmonary rehabilitation versus standard care in patients undergoing surgical resection for lung cancer.

BACKGROUND: Non-small cell lung cancer is the most common type of lung cancer. Surgery is proven to be the most effective treatment in early stages, despite its potential impact on quality of life. Pulmonary rehabilitation, either before or after surgery, is associated with reduced morbidity related symptoms and improved exercise capacity, lung function and quality of life. METHODS: We describe the study protocol for the open-label randomized controlled trial we are conducting on patients affected by primary lung cancer (stages I-II) eligible for surgical treatment. The control group receives standard care consisting in one educational session before surgery and early inpatient postoperative physiotherapy. The treatment group receives, in addition to standard care, intensive rehabilitation involving 14 preoperative sessions (6 outpatient and 8 home-based) and 39 postoperative sessions (15 outpatient and 24 home-based) with aerobic, resistance and respiratory training, as well as scar massage and group bodyweight exercise training. Assessments are performed at baseline, the day before surgery and one month and six months after surgery. The main outcome is the long-term exercise capacity measured with the Six-Minute Walk Test; short-term exercise capacity, lung function, postoperative morbidity, length of hospital stay, quality of life (Short Form 12), mood disturbances (Hospital Anxiety and Depression Scale) and pain (Numeric Rating Scale) are also recorded and analysed. Patient compliance and treatment-related side effects are also collected. Statistical analyses will be performed according to the intention-to-treat approach. T-test for independent samples will be used for continuous variables after assessment of normality of distribution. Chi-square test will be used for categorical variables. Expecting a 10% dropout rate, assuming α of 5% and power of 80%, we planned to enrol 140 patients to demonstrate a statistically significant difference of 25 m at Six-Minute Walk Test. DISCUSSION: Pulmonary Resection and Intensive Rehabilitation study (PuReAIR) will contribute significantly in investigating the effects of perioperative rehabilitation on exercise capacity, symptoms, lung function and long-term outcomes in surgically treated lung cancer patients. This study protocol will facilitate interpretation of future results and wide application of evidence-based practice. TRIAL REGISTRATION: ClinicalTrials.gov Registry n. NCT02405273 [31.03.2015].

Opportunistic omnivory impairs the use of the Atlantic blue crab Callinectes sapidus as a trace metal biomonitor in invaded Mediterranean coastal waters.

The contribution of non-indigenous species to the transfer of contaminants in invaded food webs represents an active research area. Here we measured trace metals and CN stable isotopes in five populations of the invasive Atlantic blue crab Callinectes sapidus and in baseline bivalve species from Spain, Italy and Greece. They were used to estimate trophic transfer effects and the trophic position and isotopic niche of C. sapidus. Maximum trophic transfer effects occurred where the crab showed the largest isotopic niches and highest trophic positions; furthermore, the consistency of trace metal profiles between bivalves and crabs co-varied with the trophic position of the latters. Omnivory may influence the success of an invasive species, but also limit its effectiveness for biomonitoring. However, our results indicated that stable isotopes analysis provides a clarifying background where to cast patterns of contamination of the blue crab as well as of other omnivorous biomonitor species.

Isotopic Overlap of Invasive and Native Consumers in the Food Web of Lake Trasimeno (Central Italy).

An advanced characterization of the trophic niche of non-indigenous species (NIS) may provide useful information on their ecological impact on invaded communities. Here, we used carbon and nitrogen stable isotopes to estimate pairwise niche overlaps between non-indigenous and native consumers in the winter food web of Lake Trasimeno (central Italy). Overall, a relatively low pairwise overlap of isotopic niches was observed between NIS and native species. The only exception was the Louisiana crayfish Procambarus clarkii, which showed a relatively high and diffuse overlap with other native invertebrates. Our findings highlighted a high niche divergence between non-indigenous and native species in Lake Trasimeno, suggesting a potentially low degree of interspecific competition that may facilitate coexistence and, in turn, limit the strength of impacts. The divergent results obtained for the Louisiana crayfish indicate that additional control measures for this invasive species are needed to mitigate its impact on the Lake Trasimeno system.

Individual and population-scale carbon and nitrogen isotopic values of Procambarusclarkii in invaded freshwater ecosystems.

Background: Freshwater ecosystems are amongst the most threatened habitats on Earth; nevertheless, they support about 9.5% of the known global biodiversity while covering less than 1% of the globe's surface. A number of anthropogenic pressures are impacting species diversity in inland waters and, amongst them, the spread of invasive alien species is considered one of the main drivers of biodiversity loss and homogenisation in freshwater habitats.Crayfish species are widely distributed freshwater invaders and, while alien species introductions occur mostly accidentally, alien crayfish are often released deliberately into new areas for commercial purposes. After their initial introduction, crayfish species can rapidly establish and reach high-density populations as a result of their adaptive functional traits, such as their generalist diet.The Louisiana crayfish Procambarusclarkii (Girard, 1852) is globally considered one of the worst invaders and its impact on recipient freshwater communities can vary from predation and competition with native species, to modification of food webs and habitat structure and introduction of pathogens. Native to the south United States and north Mexico, P.clarkii has been introduced in Europe, Asia and Africa, determining negative ecological and economic impacts in the majority of invaded habitats where it became dominant within the receiving benthic food webs. Due to its flexible feeding strategy, P.clarkii exerts adverse effects at different trophic levels, ultimately affecting the structure and dynamics of invaded food webs. It is, therefore, paramount to evaluate the ecological consequences of P.clarkii invasion and to quantify its impact in a spatially explicit context. New information: In the past decades, the analysis of stable isotopes of carbon, nitrogen and other elements has become a popular methodology in food web ecology. Notably, stable isotope analysis has emerged as a primary tool for addressing applied issues in biodiversity conservation and management, such as the assessment of the trophic ecology of non-indigenous species in invaded habitats. Here, we built two geo-referenced datasets, resolved respectively at the population and individual scale, by collating information on δ13C and δ15N values of P.clarkii within invaded inland waters. The population-scale dataset consists of 160 carbon and nitrogen isotopic values of the Louisiana crayfish and its potential prey, including living and non-living primary producers and benthic invertebrates. The dataset resolved at individual scale consists of 1,168 isotopic records of P.clarkii. The isotopic values included within the two datasets were gathered from 10 countries located in Europe, Asia, Africa and North America, for a total of 41 studies published between 2005 and 2021. To the best of the authors' knowledge, this effort represents the first attempt to collate in standardised datasets the sparse isotopic information of P.clarkii available in literature. The datasets lend themselves to being used for providing a spatially explicit resolution of the trophic ecology of P.clarkii and to address a variety of ecological questions concerning its ecological impact on recipient aquatic food webs.

An individual-based dataset of carbon and nitrogen isotopic data of Callinectessapidus in invaded Mediterranean waters.

BACKGROUND: The characterisation of functional traits of non-indigenous and invasive species is crucial to assess their impact within invaded habitats. Successful biological invasions are often facilitated by the generalist diet of the invaders which can modify their trophic position and adapt to new ecosystems determining changes in their structure and functioning. Invasive crustaceans are an illustrative example of such mechanisms since their trophic habits can determine important ecological impacts on aquatic food webs. The Atlantic blue crab Callinectessapidus is currently established and considered invasive in the Mediterranean Sea where it has been recorded for the first time between 1947 and 1949. In the last decade, the blue crab colonised most of the eastern and central Mediterranean Sea and the Black Sea and it is currently widening its distribution towards the western region of the basin. NEW INFORMATION: Stable isotope analysis is increasingly used to investigate the trophic habits of invasive marine species. Here, we collated individual measures of the blue crab δ13C and δ15N values and of its potential invertebrate prey into a geo-referenced dataset. The dataset includes 360 records with 236 isotopic values of the blue crab and 224 isotopic data of potential prey collected from five countries and 12 locations between 2014 and 2019. This dataset allows the estimation of the trophic position of the blue crab within a variety of invaded ecosystems, as well as advanced quantitative comparisons of the main features of its isotopic niche.

A global occurrence database of the Atlantic blue crab Callinectes sapidus.

The Atlantic blue crab Callinectes sapidus is a portunid native to the western Atlantic, from New England to Uruguay. The species was introduced in Europe in 1901 where it has become invasive; additionally, a significant northward expansion has been emphasized in its native range. Here we present a harmonized global compilation of C. sapidus occurrences from native and non-native distribution ranges derived from online databases (GBIF, BISON, OBIS, and iNaturalist) as well as from unpublished and published sources. The dataset consists of 40,388 geo-referenced occurrences, 39,824 from native and 564 from non-native ranges, recorded in 53 countries. The implementation of quality controls imposed a severe reduction, in particular from online databases, of the records selected for inclusion in the dataset. In addition, a technical validation procedure was used to flag entries showing identical coordinates but different year of record, in-land occurrences and those located close to the coast. Similarly, a flagging system identified entries outside the known distribution of the species, or associated with unsuccessful introductions.

The Codivilla spring: from then to now and beyond.

The ankle-foot-orthosis (AFO), originally called Codivilla spring, is an orthotic device prescribed to the patients with foot drop due to neurological diseases in order to control the range of motion of the ankle joint and to compensate the muscle weakness/spasticity, thus optimizing the gait function. In this paper, a historical revision of the most known and used AFO worldwide from the origin of its name and the first applications at the Rizzoli Orthopedic Institute to the most advanced solutions in use today is covered. Through the critical analysis of the historical documents available, the paper reports on the controversy about the true inventor of the Codivilla spring during the first decades of the XX century. In terms of their design and indications, adult and child AFOs are presented. Finally, possible approaches for the selection of the correct orthosis and the individual prescription are discussed in order to manage specific mechanical neuromuscular deficiencies of the subject's ankle-foot complex, optimizing walking efficiency.

The tolerance of physiotherapy treatment in patients with COVID-19 and undergoing surgery for fragility hip fracture: An observational study.

ABSTRACT: The aim of the present work was to evaluate the tolerance of physiotherapy treatment implemented for patients with coronavirus disease (COVID-19) and undergoing hip surgeryCase-control study. During the period between March and May 2020, 9 patients were enrolled in the study with diagnosis of COVID-19 and hip fracture. In order to evaluate the tolerability of physiotherapy treatment a comparison group, involving 27 patients with a hip fracture but in the absence of suspicion of COVID-19 positivity, were put together. Blood saturation and heart rate, number of physiotherapy sessions, start of physiotherapy from surgery, number of healthcare providers, recovery of ambulation, execution of walking training and dyspnea measured by Borg scale were collected before and after each single physiotherapy session to describe the exercise tolerance of the patients.There are no significant differences between the two groups regarding basic characteristics. Average of Borg scale post treatment for COVID patients was 1.3 (DS = 1.3) compared to 0.6 (DS = 0.7) of non-COVID patients (P < .0005) but the breathing difficulty was light during the treatment, only 9% of COVID patients had a worsening superior of two points with Borg scale compared to 3% of non-COVID patients (P = .138). The incidence of walking recovery was 63% in the non-COVID patients group compared to 44.4% in the COVID group (P = .329).Physiotherapy treatment of patients with COVID-19 infection and undergoing surgery for hip fracture is well tolerated and should be encouraged and well monitored.

Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia?

BACKGROUND: Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown. OBJECTIVE: To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters. METHODS: Postal survey. Patients with trans-femoral, trans-tibial or hemi-pelvectomy amputation were asked to partake in the study. The Prosthetic Evaluation Questionnaire was used for the presence of chronic post-surgical pain. Use of catheters was retrieved from medical notes. RESULTS: 57 patients at a mean of 4.4 years follow up were included. PLS was reported in 68.4%, PLP in 63.2 % and RLP in 54.4% of amputees. No correlation was identified between pain syndromes and the presence of individual catheters and the duration of their permanence. The simultaneous use of 2 catheters was related to a lesser presence of PLP. CONCLUSIONS: Data on prevalence of PLP, PLS and RLP are consistent with the literature. Favourable effects in PLP reduction in the long term follow up was related to the simultaneous use of two catheters.

Self-Management in Stroke Survivors: Development and Implementation of the Look after Yourself (LAY) Intervention.

OBJECTIVE: Self-management is recommended in stroke rehabilitation. This report aims to describe timing, contents, and setting of delivery of a patient-centered, self-management program for stroke survivors in their early hospital rehabilitation phase: the Look After Yourself (LAY) intervention. METHODS: After extensive literature search, the LAY intervention was developed by integrating the Chronic Disease Self-Management Program, based on the self-efficacy construct of social cognitive theory, with evidence-based key elements and input from stroke survivors. RESULTS: the LAY intervention aims to implement self-management skills in stroke survivors, enabling them to be active in goal setting and problem solving using action plans and to facilitate the critical transition from hospital to community. It includes both group sessions to facilitate sharing of experiences, social comparison, vicarious learning, and increase motivation and one-to-one sessions focused on setting feasible action plans and on teaching personalized strategies to prevent falls. Standardization is ensured by manuals for facilitators and patients. CONCLUSION: The LAY intervention is the first Italian program to support early self-management in stroke rehabilitation; it has been experimented and its efficacy proven in improving self-efficacy, mental health, and activities of daily living, and detailed results have been published. The LAY intervention is described according to the TIDieR checklist.

The Look After Yourself (LAY) intervention to improve self-management in stroke survivors: Results from a quasi-experimental study.

OBJECTIVE: To test the efficacy of a self-management intervention for stroke survivors vs. usual care. METHODS: Using a quasi-experimental study, participants were recruited from three public Italian hospitals. Questionnaires assessing self-efficacy (SSEQ), quality of life (SF-12), physical performance (SPPB), depression (GDS) and activities of daily living (MBI) were administered at baseline, discharge and two months after discharge. Mixed models with a propensity score were used between experimental group (EG) and control group (CG). Logistic models were used to compare the use of health services. RESULTS: Eighty-two stroke survivors were enrolled in the EG and 103 in the CG. Self-efficacy in self-management improved in the EG compared to the CG during hospitalization. Improvements from baseline to discharge were found in the EG in the mental component of SF-12 and in MBI. The EG were 8.9 times more likely to contact general practitioners after discharge and 2.9 times to do regular exercise than CG. Notably, EG with higher education benefitted more from the intervention. CONCLUSION: The intervention was efficacious in improving self-efficacy, mental health and activities of daily living. PRACTICE IMPLICATIONS: Structured educational interventions based on problem-solving and individual goal setting may improve self-management skills in stroke survivors.

Baseline assessment of heavy metals content and trophic position of the invasive blue swimming crab Portunus segnis (Forskål, 1775) in the Gulf of Gabès (Tunisia).

This study provides a baseline assessment of cadmium, copper, iron, manganese, lead, and zinc concentrations in muscles, gills, and exoskeleton of the Lessepsian blue swimming crab Portunus segnis captured in the Gulf of Gabès (Southern Mediterranean Sea, Tunisia) in November 2015. Furthermore, the species' trophic position is estimated using CN stable isotope analysis. The exoskeleton showed the lowest metal contents; in soft tissues, the essential Cu, Fe, and Zn and the non-essential Cd, Mn, and Pb showed the highest and lowest concentrations, respectively. The crab was characterized by a trophic position of 3.32, confirming its carnivorous trophic habits. Compared with literature data on invertebrate and fish species from the same area, Cd and Pb resulted remarkably low in the crab's soft tissues, while a food web-scale dilution effect was indicated. The need of a comprehensive assessment of the ecological impact of Portunus segnis in invaded Mediterranean waters is discussed.

Beyond the mean: A comparison of trace- and macroelement correlation profiles of two lacustrine populations of the crayfish Procambarus clarkii.

In invertebrate biomonitors of chemical pollution, emphasis has been generally given to mean accumulation patterns and how they reflect varying environmental levels of contamination. Intra-population variability, and how it relates with individual phenotypic traits, has received less attention. Here, a set of analytes including trace elements (B, Ba, Cd, Cr, Cu, Fe, Li, Mn, Ni, Pb, Sr, V, and Zn), macroelements (C, Ca, K, Mg, N, Na), and carbon and nitrogen stable isotopes (δ13C and δ15N) was measured in two populations of the crayfish Procambarus clarkii from Lake Trasimeno and Lake Bolsena (Central Italy). The influence of location, sex, body size, and condition factor was assessed; in addition, the analyte correlation profiles of the two populations were compared to verify their congruence. In general, significant inter-lake differences were observed in the concentration of both trace- and macroelements in crayfish tissues, generally mirroring the local chemistry of water and of benthic non-living matrices (sediment and plant detritus). Crayfish CN isotopic signatures excluded the occurrence of inter-lake variations in their omnivorous trophic habits. Correlation profiles varied considerably between the two populations in the nature and strength of bivariate relationships. However, Mantel tests and procrustean analyses indicated a general, significant congruence; C, N, and, to a lesser extent K, Li, Ni, Pb, and δ13C showed the highest procrustean residuals, suggesting that their associations with other analytes may be partially influenced by inter-population differences in growing phases. Our study indicates that the local geochemistry of the lacustrine environment influences the elemental fingerprint of Procambarus clarkii; the considerable inter-individual variability in the concentration of analytes, however, does not significantly reflect on their association, thus corroborating its effectiveness as an indicator species.

Self-management and self-efficacy in stroke survivors: validation of the Italian version of the Stroke Self-Efficacy Questionnaire.

BACKGROUND: Self-efficacy is an important mediator of the adaptation process after stroke. However, few studies have attempted to measure self-efficacy in a stroke population. The most recently developed scale is the Stroke Self-Efficacy Questionnaire that measures self-efficacy ratings in specific domains of functioning relevant for a stroke survivor. AIM: The aim of this study was to validate the Italian version of Stroke Self-efficacy Questionnaire in stroke survivors. DESIGN: Cross-sectional study. SETTING: Three Physical Medicine and Rehabilitation Units located in public hospitals. POPULATION: 149 adult patients recruited after their first stroke. METHODS: Patients were assessed using the Self-efficacy in stroke survivors questionnaire, the Modified Barthel Index, the Geriatric Depression Scale and the Short Form Health Survey. RESULTS: Patients (38.3% female, mean age 69.3 years) completed the Self-efficacy in stroke survivors questionnaire with the help of an interviewer. Using confirmatory factor analysis two factors were identified (activity and self-management). The factor score 'activity' was significantly associated with the Modified Barthel Index and with the physical component of the Short Form Health Survey, but uncorrelated with the mental component of the Short Form Health Survey and with the Geriatric Depression Scale, supporting the convergent/discriminant validity of the instrument. The 'self-management' factor was weakly associated with the Modified Barthel Index, the physical and mental components of the Short Form Health Survey and uncorrelated with the Geriatric Depression Scale, suggesting that it measures a different construct. When we categorized patients according to their walking status, we found that the walking group had significantly higher scores on the activity factor than the non-walking group, while no significant differences were found concerning the self-management factor. CONCLUSIONS: The findings supported the validity of the Italian version of the Stroke Self-efficacy questionnaire . It measures two dimensions of self-efficacy, activity and self-management, strongly related to independence and recovery after stroke and therefore it represents a useful tool to assess self-efficacy. CLINICAL REHABILITATION IMPACT: The Italian version of the Stroke Self-efficacy questionnaire is a valid and reliable measure of self-efficacy. Clinicians can use this instrument to target rehabilitation interventions according to patients' individual confidence in their functional and self-management capacity and in order to set realistic goals.

Perioperative physical exercise interventions for patients undergoing lung cancer surgery: What is the evidence?

Surgical resection appears to be the most effective treatment for early-stage non-small cell lung cancer. Recent studies suggest that perioperative pulmonary rehabilitation improves functional capacity, reduces mortality and postoperative complications and enhances recovery and quality of life in operated patients. Our aim is to analyse and identify the most recent evidence-based physical exercise interventions, performed before or after surgery. We searched in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsycINFO. We included randomised controlled trials aimed at assessing efficacy of exercise-training programmes; physical therapy interventions had to be described in detail in order to be reproducible. Characteristics of studies and programmes, results and outcome data were extracted. Six studies were included, one describing preoperative rehabilitation and three assessing postoperative intervention. It seems that the best preoperative physical therapy training should include aerobic and strength training with a duration of 2-4 weeks. Although results showed improvement in exercise performance after preoperative pulmonary rehabilitation, it was not possible to identify the best preoperative intervention due to paucity of clinical trials in this area. Physical training programmes differed in every postoperative study with conflicting results, so comparison is difficult. Current literature shows inconsistent results regarding preoperative or postoperative physical exercise in patients undergoing lung resection. Even though few randomised trials were retrieved, treatment protocols were difficult to compare due to variability in design and implementation. Further studies with larger samples and better methodological quality are urgently needed to assess efficacy of both preoperative and postoperative exercise programmes.