Longitudinal associations of light-intensity physical activity with quality of life, functioning and fatigue after colorectal cancer.

PURPOSE: Evidence from cross-sectional studies suggests that higher levels of light-intensity physical activity (LPA) are associated with better health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors. However, these associations have not been investigated in longitudinal studies that provide the opportunity to analyse how within-individual changes in LPA affect HRQoL. We investigated longitudinal associations of LPA with HRQoL outcomes in CRC survivors, from 6 weeks to 2 years post-treatment. METHODS: Data were used of a prospective cohort study among 325 stage I-III CRC survivors (67% men, mean age: 67 years), recruited between 2012 and 2016. Validated questionnaires were used to assess hours/week of LPA (SQUASH) and HRQoL outcomes (EORTC QLQ-C30, Checklist Individual Strength) at 6 weeks, and 6, 12 and 24 months post-treatment. We applied linear mixed regression to analyse longitudinal confounder-adjusted associations of LPA with HRQoL. RESULTS: We observed statistically significant longitudinal associations between more LPA and better global quality of life and physical, role and social functioning, and less fatigue over time. Intra-individual analysis showed that within-person increases in LPA (per 8 h/week) were related to improved HRQoL, including better global quality of life (ß = 1.67, 95% CI 0.71; 2.63; total range scale: 0-100) and less fatigue (ß = - 1.22, 95% CI - 2.37; - 0.07; scale: 20-140). Stratified analyses indicated stronger associations among participants below the median of moderate-to-vigorous physical activity (MVPA) at diagnosis. CONCLUSION: Higher levels of LPA were longitudinally associated with better HRQoL and less fatigue in CRC survivors up to two years post-treatment. Further prospective studies using accelerometer data are necessary to inform development of interventions targeting LPA.

Influence of lung transplantation on the essential fatty acid profile in cystic fibrosis.

Lung transplantation is assumed to normalize essential fatty acid (EFA) profile in the plasma, described as abnormal in patients with cystic fibrosis (CF). This study sought to evaluate the EFA profile in both the plasma and erythrocyte membrane according to lung status by comparing CF patients with or without a lung transplant. A total of 50 homozygous F508del patients (33 CF patients [CF group] and 17 CF patients with a lung transplant [TX CF group]) were included. In comparison with the CF group, in the plasma, the levels of total n-3, α-linolenic, eicosapentaenoic, and docosahexaenoic acids were higher and the n-6/n-3 ratio was lower in the TX CF group. Yet, these differences were not observed in the erythrocyte membrane. This study supports that lung transplantation improves the EFA profile in the plasma but not in the erythrocyte membrane by means of the different mechanisms suggested in this article.

Arrhythmogenic response to isoproterenol testing vs. exercise testing in arrhythmogenic right ventricular cardiomyopathy patients.

Aims: To compare the arrhythmic response to isoproterenol and exercise testing in newly diagnosed arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. Methods and results: We studied isoproterenol [continuous infusion (45 µg/min) for 3 min] and exercise testing (workload increased by 30 W every 3 min) performed in consecutive newly diagnosed ARVC patients. Both tests were evaluated with regard to the incidence of (i) polymorphic premature ventricular contractions (PVCs) and couplet(s) or (ii) sustained or non-sustained ventricular tachycardia (VT) with left bundle branch block [excluding right ventricular outflow tract VT]; and compared to a control group referred for the evaluation of PVCs without structural heart disease. Thirty-seven ARVC patients (63.5% male, age 38 ± 16 years) were included. The maximal sinus rhythm heart rate achieved during isoproterenol testing was significantly lower compared to exercise testing (149 ± 17 bpm vs. 166 ± 19 bpm, P < 0.0001). However, the incidence of polymorphic ventricular arrhythmias was much higher during isoproterenol testing compared to exercise testing [33/37 (89.2%) vs. 16/37 (43.2%), P < 0.0001]. Interestingly, isoproterenol testing was arrhythmogenic in all 15 patients in whom baseline PVCs were reduced or suppressed during exercise testing. During both isoproterenol and exercise testing, control group presented a low incidence of ventricular arrhythmias compared to ARVC patients (8.1% vs. 89.2%, P < 0.0001 and 2.7% vs. 43.2%, P < 0.0001, respectively). Conclusions: The incidence of polymorphic ventricular arrhythmias is significantly higher during isoproterenol compared to exercise testing in newly diagnosed ARVC patients, suggesting its potential utility for the diagnosis.

A Multicentre Trial of Patient specific Rehearsal Prior to EVAR: Impact on Procedural Planning and Team Performance.

OBJECTIVE: Patient specific rehearsal (PsR) prior to endovascular aneurysm repair (EVAR) enables the endovascular team to practice and evaluate the procedure prior to treating the real patient. This multicentre trial aimed to evaluate the utility of PsR prior to EVAR as a pre-operative planning and briefing tool. MATERIAL AND METHODS: Patients with an aneurysm suitable for EVAR were randomised to pre-operative or post-operative PsR. Before and after the PsR, the lead implanter completed a questionnaire to identify any deviation from the initial treatment plan. All team members completed a questionnaire evaluating realism, technical issues, and human factor aspects pertinent to PsR. Technical and human factor skills, and technical and clinical success rates were compared between the randomised groups. RESULTS: 100 patients were enrolled between September 2012 and June 2014. The plan to visualise proximal and distal landing zones was adapted in 27/50 (54%) and 38/50 (76%) cases, respectively. The choice of the main body, contralateral limb, or iliac extensions was adjusted in 8/50 (16%), 17/50 (34%), and 14/50 (28%) cases, respectively. At least one of the abovementioned parameters was changed in 44/50 (88%) cases. For 100 EVAR cases, 199 subjective questionnaires post-PsR were completed. PsR was considered to be useful for selecting the optimal C-arm angulation (median 4, IQR 4-5) and was recognised as a helpful tool for team preparation (median 4, IQR 4-4), to improve communication (median 4, IQR 3-4), and encourage confidence (median 4, IQR 3-4). Technical and human factor skills and technical and initial clinical success rates were similar between the randomisation groups. CONCLUSION: PsR prior to EVAR has a significant impact on the treatment plan and may be useful as a pre-operative planning and briefing tool. Subjective ratings indicate that this technology may facilitate planning of optimal C-arm angulation and improve non-technical skills. TRIAL REGISTRATION: URL://www.clinicaltrials.gov. Unique identifier: NCT01632631.

The clinical benefits of long-term supplementation with omega-3 fatty acids in cystic fibrosis patients - A pilot study.

Effectiveness of omega-3 supplementation in cystic fibrosis (CF) remains controversial. This study sought to evaluate clinical status, exercise tolerance, inflammatory parameters, and erythrocyte fatty acid profile after 1 year of oral omega-3 supplementation in CF patients. Fifteen ΔF508-homozygous patients undergoing chronic azithromycin were randomized to receive omega-3 fish oil supplementation at a dose of 60mg/Kg/day or placebo. In comparison with the previous year, in the supplemented group, the number of pulmonary exacerbations decreased at 12 months (1.7 vs. 3.0, p<0.01), as did the duration of antibiotic therapy (26.5 days vs. 60.0 days, p<0.025). Supplementation significantly increased the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as early as <3 months of administration, with concomitant decreases in arachidonic acid (AA) levels. This pilot study suggests that long-term omega-3 supplementation offers several clinical benefits as to the number of exacerbations and duration of antibiotic therapy in CF patients.

Anodal transcranial direct current stimulation enhances time to task failure of a submaximal contraction of elbow flexors without changing corticospinal excitability.

BACKGROUND: The increase in corticospinal excitability in response to anodal transcranial direct current stimulation (a-tDCS) may contribute to decrease neuromuscular fatigability. OBJECTIVE: This study investigated the effects of a-tDCS on neuromuscular fatigability in relation with changes in corticospinal excitability. METHODS: Eleven adults participated in two experimental sessions consisting of two submaximal voluntary contractions (35% maximal torque) performed to failure, one hour apart with the right elbow flexor muscles. Sham stimulation (90 s) and a-tDCS (10 min) were applied in two separate sessions 10 min prior to the second fatiguing contraction. Corticospinal excitability was assessed by recording motor-evoked potential (MEP), elicited by transcranial magnetic stimulation (TMS) of the motor cortex, in biceps brachii, brachioradialis and triceps brachii during the first (C1) and second (C2) fatiguing contractions. The silent period (SP) in electromyogramme (EMG) that followed MEP was also recorded for biceps brachii and brachioradialis. RESULTS: Time to failure was briefer for C2 than C1 in both experimental sessions, but the decrease was less pronounced after a-tDCS (-14.4±12.7%) than sham stimulation (-23.3±11.9%; p=0.04). MEP amplitude (+9.7±4.0%) and SP duration (+22.5±12.8%) in biceps brachii and brachioradialis increased significantly (p<0.05) during C1 and C2, but to a similar extent in both sessions (p>0.05). A similar result was observed for MEP amplitude in triceps brachii. No association was found between changes in time to task failure of C2 and corticospinal excitability. CONCLUSION: The reduced neuromuscular fatigability induced by a-tDCS does not rely on changes in the excitability of the corticospinal pathway of both agonist and antagonist muscles.

Presynaptic inhibition of soleus Ia afferents does not vary with center of pressure displacements during upright standing.

The present work was designed to investigate the presynaptic modulation of soleus Ia afferents with the position and the direction of the displacement of the center of pressure (CoP) during unperturbed upright standing and exaggerated CoP displacements in young adults. Hoffmann (H) reflex was evoked in the soleus by stimulating the tibial nerve at the knee level. Modulation of Ia presynaptic inhibition was assessed by conditioning the H reflex with fibular nerve (D1 inhibition) and femoral nerve (heteronymous facilitation) stimulation. Leg muscle activity was assessed by electromyography (EMG). The results indicate that in unperturbed standing and exaggerated CoP displacements, the H-reflex amplitude was greater during forward than backward CoP direction (p<0.05). However, the amplitude of the conditioned H reflex (expressed relative to unconditioned H reflex) did not vary with CoP displacement, regardless of the experimental condition. The soleus EMG was greater during forward than backward CoP direction and during anterior than posterior position in both experimental conditions (p<0.05). The modulation of the unconditioned H reflex with CoP direction was positively associated with the corresponding changes in soleus EMG (r(2)>0.34). The tibialis anterior EMG did not change during unperturbed standing, but was greater for backward than forward CoP direction during exaggerated CoP displacements. In this experimental condition, soleus EMG was negatively associated with tibialis anterior EMG (r(2)=0.81). These results indicate that Ia presynaptic inhibition is not modulated with CoP direction and position, but rather suggest that CoP displacements induced changes in excitability of the soleus motor neuron pool.

Independent modulation of corticospinal and group I afferents pathways during upright standing.

Balance control during upright standing is accompanied by an increased amplitude of motor-evoked potentials (MEP) induced by transcranial magnetic stimulation and a decreased amplitude of the Hoffmann (H) reflex in the soleus muscle. Nonetheless, whether these observations reflect reciprocal adjustments between corticospinal and group I afferents pathways during upright standing remains unknown. To further investigate this question, cathodal transcranial direct current stimulation (c-tDCS) applied over the motor cortex and vibration of Achilles tendons were used to modify the excitability of corticospinal and group I afferent pathways, respectively. MEPs and H reflexes were recorded in the soleus muscle during upright standing with or without bilateral Achilles tendon vibration, these recordings being performed before and after 20 min of c-tDCS (1.5 mA) or sham stimulation applied over the sensorimotor cortex. The results indicate that tendon vibration increased MEP amplitude (+28%) and decrease (-68%) the H-reflex amplitude (p<0.05). After c-tDCS, MEP amplitude was reduced by 13% and 26% without and with tendon vibration (p<0.05), respectively. In contrast, no significant change occurred in H-reflex amplitude after c-tDCS. Regardless of the conditions (c-tDCS and tendon vibration), no significant correlation was observed between changes in MEP and H-reflex amplitudes. The results failed to demonstrate close reciprocal changes in soleus MEP and H-reflex amplitudes during upright standing. These original findings suggest independent adjustments in corticospinal and group I afferents pathways during upright standing.

The therapeutic implications of an abdominal aortic aneurysm with coincident horseshoe kidney.

Two male patients were admitted to the department of vascular surgery for treatment of a large infrarenal abdominal aortic aneurysm (AAA) and an associated horseshoe kidney (HSK). Both patients were successfully treated by endovascular aneurysm repair (EVAR). Horseshoe kidney is a rare and complex congenital anomaly, which increases significantly the technical difficulty of conventional surgical repair of an associated AAA. Appropriate preoperative evaluation of the vascular supply of the HSK by CT- angiography and renal function is mandatory for optimal planning of the treatment strategy. EVAR is regarded as a valuable alternative to open surgical therapy, in the absence of renal failure and provided that accessory renal arteries are absent or small.

Vision and proprioception do not influence the excitability of the corticomotoneuronal pathway during upright standing in young and elderly adults.

This study investigated the influence of vision and proprioception on the excitability of direct corticospinal (corticomotoneuronal) pathway to the soleus in young and elderly adults during upright standing. Ten young and 10 elderly adults stood upright on a rigid surface with eyes open or closed, and on foam mat with eyes open. The corticomotoneuronal excitability was investigated by assessing facilitation of the soleus H-reflex induced by subthreshold transcranial magnetic stimulation (TMS). The torque produced by the plantar flexor muscles during a maximal voluntary contraction was also measured. The maximal plantar flexion torque was significantly lower in elderly than in young adults (p<0.05). The activity of leg muscles, recorded by electromyography (EMG) was greater in elderly than in young adults regardless of balance conditions (p<0.05), and greater when standing on foam than in the other conditions (p<0.05), regardless of age. The H-reflex facilitation was greater for elderly [182.9 (45)%] than young adults [130.5 (33.1)%; p<0.05] but did not differ across sensory conditions (p>0.05). However, the amplitude of the H reflex conditioned by TMS relative to the amplitude of the test H reflex ratio was positively associated with EMG activity of the plantar flexor muscles during upright standing (r(2)=0.47; p<0.001). These results indicate that regardless of age the excitability of the corticomotoneuronal pathway is not modulated with changes in the sensory conditions during upright standing. Nonetheless, the corticomotoneural drive to control leg muscle during upright standing increases with the level of soleus muscle activity.

Input-output characteristics of soleus homonymous Ia afferents and corticospinal pathways during upright standing differ between young and elderly adults.

AIM: This study investigated the effects of ageing on the excitability of soleus homonymous Ia afferents and corticospinal pathways during bipedal upright standing. METHODS: The input-output relations for the Hoffmann (H) reflex and motor-evoked potential (MEP) were computed for the soleus in response to electrical nerve stimulation and transcranial magnetic stimulation, respectively, in young (n = 16) and elderly (n = 16) adults. In subsets of subjects, the input-output relations were compared between normal and supported upright standing, and corticomotoneuronal excitability was assessed during upright standing with an H-reflex conditioning method. For the H-reflex and MEP threshold, maximal amplitude (Hmax , MEPmax ) and the slope of the input-output relation (Hslope , MEPslope ) were measured and normalized to the corresponding M-wave value. RESULTS: In normal standing, the Hmax /Mmax [mean (SD); young: 48.3 (14.2)%; elderly: 17.3 (6.4)%] and Hslope /Mslope were significantly (P < 0.05) lower in elderly than in young adults, whereas the MEPmax /Mmax [young: 13.6 (7.5)%; elderly: 24.5 (12.8)%] and MEPslope /Mslope were greater in elderly adults (P < 0.05). The Hslope /Mslope and MEPslope /Mslope decreased and increased, respectively, from supported to normal standing for both age groups but more so in elderly adults. Furthermore, the conditioned H reflex was greater (P < 0.05) in elderly [175.1 (34.3)%] than in young adults [141.8 (29.8)%] during normal standing. CONCLUSION: This is the first study that clearly indicates lower efficacy of Ia afferents to discharge spinal motor neurones accompanied by greater corticospinal excitability in elderly adults, suggesting an increased contribution of the descending drive in controlling soleus activity during upright standing with ageing.

[Actuality with the breast implants]. / Actualités des implants mammaires.

The author presents the history of breast implants, and the modern evolution where breast implants are largely used in both cosmetic and reconstructive surgery. Breast augmentation is one of the most performed cosmetic procedures, with a high satisfaction rate. However, one needs to remind that breast implants have a limited duration of life. The estimated rate of breast implant rupture after 10 years is of 10% in the current literature, This rate will probably become lower with the new more cohesive implants recently available on the market. It is therefore essential to propose a regular follow-up to all patients having breast implants. This follow-up is performed using a combination of physical examination, mammograms, ultrasound and MRI. The more specific therapeutic approach for patients having a PIP prosthesis will also be discussed.

Floating aortic thrombus: the endovascular approach.

CASE REPORT: We report a 71-year-old obese white female who presented with sudden right calf pain after a long distance flight. Symptoms were initially regarded as venous in origin. Duplex investigation ruled out deep vein thrombosis. Ultimately she presented to our department with complaints of claudication. Clinical evaluation and a new duplex scan showed occlusion of the right popliteal artery. Further evaluation with CT-angiography showed, besides occlusion of the right popliteal artery, a floating thrombus in the infrarenal abdominal aorta. The thrombus was treated with a bare-metal stent placed through a femoral approach. CT-scans at 1 and 3 months demonstrated complete exclusion of the thrombus. The claudication of the right calf resolved spontaneously. Floating thrombus of the infrarenal abdominal aorta is a rare cause of distal arterial embolisation. CT-scan with contrast enhancement is the preferred diagnostic technique. Endovascular repair seems to be the treatment of choice and in our opinion a covered stent is not required. Anticoagulation therapy needs to be guided on an individual patient basis

Patient-specific rehearsal prior to EVAR: a pilot study.

OBJECTIVES: This study aims to evaluate feasibility, face validity, influence on technical factors and subjective sense of utility of patient-specific rehearsal (PsR) prior to endovascular aortic aneurysm repair (EVAR). DESIGN: A prospective, multicentre pilot study. METHODS: Patients suitable for EVAR were enrolled and a three-dimensional (3D) model of the patient's anatomy was generated. Less than 24 h prior to the real case, rehearsals were conducted in the laboratory or clinical angiosuite. Technical metrics were recorded during both procedures. A subjective questionnaire was used to evaluate realism, technical and human factor aspects (scale 1-5). RESULTS: Ten patients were enrolled. In one case, the treatment plan was altered based on PsR. In 7/9 patients, the rehearsal significantly altered the optimal C-arm position for the proximal landing zone and an identical fluoroscopy angle was chosen in the real procedure. All team members found the rehearsal useful for selecting the optimal fluoroscopy angle (median 4). The realism of the EVAR procedure simulation was rated highly (median 4). All team members found the PsR useful to prepare the individual team members and the entire team (median 4). CONCLUSIONS: PsR for EVAR permits creation of realistic case studies. Subjective evaluation indicates that it may influence optimal C-arm angles and be valuable to prepare the entire team. A randomised controlled trial (RCT) is planned to evaluate how this technology may influence technical and team performance, ultimately leading to improved patient safety.

Endovascular treatment of a chronic contained ruptured abdominal aortic aneurysm.

CASE REPORT: We report a 69-year-old Caucasian male who presented with irreversible ischemia to the left foot. CT-scan showed, besides occlusion of both superficial femoral arteries, a chronic contained rupture of an abdominal aortic aneurysm. The aneurysm was excluded with a stent graft placed through a femoral approach in a semi-urgent procedure. CT-scans at 1, 3 and 6 months demonstrated continued exclusion of the aneurysm. Chronic ruptures are a rare but important subset of ruptured abdominal aortic aneurysms. CT-scan with contrast enhancement is the gold standard diagnosing technique. Treatment consists of prompt surgical intervention with endovascular repair being increasingly used as an alternative to an open surgical approach.

Leiomyosarcoma of the inferior nasal concha: a case report and literature review.

Leiomyosarcomas (LMSs) of the sinonasal tracts are rarely reported. We present a case of an LMS of the left inferior nasal concha, and discuss the management options with review of the literature. A 72-year-old female patient presented with epistaxis. Clinical examination and medical imaging showed a tumour arising from the left inferior nasal concha. An endoscopic resection was performed. Anatomopathological and immunohistochemical analyses revealed the tumour to be a grade 3 LMS with uncertain posterior margins. The patient was a Jehovah's Witness and refused more radical surgical resection due to religious beliefs; therefore, adjuvant conformal radiotherapy (60 Gy) was performed. LMS of the nasal cavity is a rare and locally aggressive tumour with a high tendency of recurrence, requiring radical surgical resection and long-term follow-up. The prognosis of a nasal cavity LMS is better than that of an LMS located in the paranasal sinuses.

A MIP-based impedimetric sensor for the detection of low-MW molecules.

Mimicking the selectivity and sensitivity of biological systems for sensor devices is of increasing interest in biomedical, environmental and chemical analysis. Synthetic materials with imprinted nanocavities, acting as highly selective artificial receptors, are a tailor-made solution in obtaining such a sensor. Incorporation of such molecularly imprinted polymers (MIPs) in a platform suitable for electrochemical measurements, can offer high sensitivity together with device miniaturization and an electronic read-out. As a proof of principle, a MIP-based sensor for L-nicotine has been developed. To this end, the molecular structure of L-nicotine was imprinted in a polymer matrix of polymethacrylic acid (PMAA). Subsequently, microparticles of the imprinted polymer were immobilized on thin films of the conjugated polymer OC(1)C(10)-PPV. These films were incorporated in an impedimetric sensing device. Using electrochemical impedance spectroscopy, the real part of the impedance was monitored for various concentrations. This setup allows for the detection of l-nicotine from 1 to 10 nM and is insensitive for the resembling molecule L-cotinine.