Effect of home-based prehabilitation on postoperative complications after surgery for gastric cancer: randomized clinical trial.

BACKGROUND: Recent studies have demonstrated that prehabilitation improves patients' physical fitness but its impact on postoperative morbidity remains unclear. This study aimed to assess the effect of personalized, multimodal, semisupervised, home-based prehabilitation on postoperative complications after surgery for gastric cancer. METHODS: This RCT was conducted at two centres in Lithuania. Patients (aged at least18 years) with gastric cancer scheduled to undergo elective primary surgery or surgery after neoadjuvant chemotherapy for gastric cancer were randomized (1 : 1) to prehabilitation or standard care. Prehabilitation included exercise interventions focused on endurance, respiratory muscle strength, stretching, and resistance training as well as nutritional and psychological support. The primary outcome was the proportion of patients with postoperative complications within 90 days after surgery. Secondary outcomes included 90-day mortality rate, physical condition, fitness level, nutritional status, quality of life, anxiety and depression level, and proportion of patients completing neoadjuvant chemotherapy. RESULTS: Between February 2020 and September 2022, 128 participants were randomized to prehabilitation (64) or standard care (64), and 122 (prehabilitation 61, control 61) were analysed. The prehabilitation group had increased physical capacity before the operation compared with baseline (mean 6-min walk test change +31 (95 per cent c.i. 14 to 48) m; P = 0.001). The prehabilitation group had a decreased rate of non-compliance with neoadjuvant treatment (risk ratio (RR) 0.20, 95 per cent c.i. 0.20 to 0.56), a 60 per cent reduction in the number of patients with postoperative complications at 90 days after surgery (RR 0.40, 0.24 to 0.66), and improved quality of life compared with the control group. CONCLUSION: Prehabilitation reduced morbidity in patients who underwent gastrectomy for gastric cancer. REGISTRATION NUMBER: NCT04223401 (http://www.clinicaltrials.gov).

Bibliometric and scientometric analysis on biomarkers and molecular mechanisms for physical frailty and sarcopenia.

Introduction: The influence of physical frailty and sarcopenia (PFS) on the well-being of older people and continuous pressure on the healthcare systems has prompted a research on the pathophysiology and molecular mechanisms of these conditions. Nonetheless some biomarkers have been suggested as potential markers for PFS none of them have been shown to highlight the complex nature of PFS, which reveals that there is a need for an understanding of the possible biomarker candidates. The aim of this study was to identify the current research hotspots, status, and trends in the field of biomarkers and molecular mechanisms for PFS. Methods: The bibliometric and scientometric analyses were performed using VOSviewer (version 1.6.18) and open source software platform Cytoscape v.3.9 (for visualizing and constructing a network of keywords). Data of publications (from 1997 to 2023) related to biomarkers and molecular mechanisms of PFS were obtained (in May 2023) from the database of Science Citation Index Expanded of Web of Science, Scopus, and PubMed. The keywords obtained from the Scopus database were used to perform a meaningful keyword analysis. A network of keyword relationships was build using Cytoscape. Results: In this study, we present biomarker keywords for PFS in relation to other keywords potentially designating processes and mechanisms and reveal the biomarker identities and current contexts in which these biomarker identities are discussed. Conclusions: Over recent years, scientific interest in the field of PFS has increased and focused on the inflammatory process and probably will be concentrated on myokines (such as cytokines and small proteins) that are synthetized and released by skeletal muscles in response to physical activity. Moreover, proteomic and genetic markers are deeply involved in PFS.

The First Wave of the COVID-19 Pandemic Strengthened the "Strong" and Weakened the "Weak" Ones.

The aim of this study was to explore how the first wave of the COVID-19 pandemic, during which contact communication was severely restricted, changed psychological health indicators, such as subjective assessment of health and depression, impulsivity, stress and emotional intelligence (EI) and how that depended on age, gender, physical activity (PA), sports specificity and body mass index (BMI).We surveyed 6369 before and 2392 people during the first wave of the COVID-19 pandemic. The participants were aged 18-74 years. Participants completed the Danish Physical Activity Questionnaire (DPAQ), the 10-item Perceived Stress Scale (PSS-10), the Schutte Self-Report Emotional Intelligence Test (SSREIT), Barratt Impulsiveness Scale Version 11 (BIS-11), subjective depression and health self-assessments. One-way and two-way analyses of variance (ANOVA) were performed to assess the effect of independent variables on the dependent variables of MVPA (METs). Statistical analysis showed that restrictions during the first wave of the COVID-19 pandemic did not alter moderate-to-vigorous physical activity (MVPA), except for a significant decrease in MVPA in women aged 18-25 years, or body mass index in women and men of different ages. An increase in depression and impulsivity was observed, especially an increase in unplanned or spontaneous activity. The restrictions during the first wave increased stress in women of all ages and, rather unexpectedly, improved health self-assessment in men.The study showed that the first wave of the COVID-19 pandemic affected people's subjective assessment of health, depression, stress and impulsivity in two ways: it "weakened the weak ones" and "strengthened the strong ones".

Personalized trimodal prehabilitation for gastrectomy.

BACKGROUND: Surgery is the only potentially curative treatment for gastric cancer, however, it bears a high postoperative morbidity and mortality rate. A recent randomized control trial proposed prehabilitation to reduce the postoperative morbidity in patients undergoing major abdominal surgery. Currently, there is a lack of evidence of using prehabilitation for patients undergoing gastrectomy for gastric cancer. The aim of our study is to demonstrate that home-based prehabilitation can reduce postoperative morbidity after gastrectomy for gastric cancer. METHODS: PREFOG is a multi-center, open-label randomized control trial comparing 90-days postoperative morbidity rate after gastrectomy for gastric cancer between patients with or without prehabilitation. One-hundred twenty-eight patients will be randomized into an intervention or control group. The intervention arm will receive trimodal home-based prehabilitation including nutritional, psychological and exercise interventions. Secondary outcomes of the study will include physical and nutritional status, anxiety and depression level, quality of life, postoperative mortality rates and full completion of the oncological treatment as determined by the multidisciplinary tumor board. DISCUSSION: PREFOG study will show if home-based trimodal prehabilitation is effective to reduce postoperative morbidity after gastrectomy for gastric cancer. Moreover, this study will allow us to determine whether prehabilitation can improve physical fitness and activity levels, nutritional status and quality of life as well as reducing anxiety and depression levels after gastrectomy for gastric cancer. TRIAL REGISTRATION: ClinicalTrials.gov NCT04223401 (First posted: 10 January 2020).