Applicability of the CT Radiomics of Skeletal Muscle and Machine Learning for the Detection of Sarcopenia and Prognostic Assessment of Disease Progression in Patients with Gastric and Esophageal Tumors.

PURPOSE: Sarcopenia is considered a negative prognostic factor in patients with malignant tumors. Among other diagnostic options, computed tomography (CT), which is repeatedly performed on tumor patients, can be of further benefit. The present study aims to establish a framework for classifying the impact of sarcopenia on the prognosis of patients diagnosed with esophageal or gastric cancer. Additionally, it explores the significance of CT radiomics in both diagnostic and prognostic methodologies. MATERIALS AND METHODS: CT scans of 83 patients with esophageal or gastric cancer taken at the time of diagnosis and during a follow-up period of one year were evaluated retrospectively. A total of 330 CT scans were analyzed. Seventy three of these patients received operative tumor resection after neoadjuvant chemotherapy, and 74% of the patients were male. The mean age was 64 years (31-83 years). Three time points (t) were defined as a basis for the statistical analysis in order to structure the course of the disease: t1 = initial diagnosis, t2 = following (neoadjuvant) chemotherapy and t3 = end of the first year after surgery in the "surgery" group or end of the first year after chemotherapy. Sarcopenia was determined using the psoas muscle index (PMI). The additional analysis included the analysis of selected radiomic features of the psoas major, quadratus lumborum, and erector spinae muscles at the L3 level. Disease progression was monitored according to the response evaluation criteria in solid tumors (RECIST 1.1). CT scans and radiomics were used to assess the likelihood of tumor progression and their correlation to sarcopenia. For machine learning, the established algorithms decision tree (DT), K-nearest neighbor (KNN), and random forest (RF) were applied. To evaluate the performance of each model, a 10-fold cross-validation as well as a calculation of Accuracy and Area Under the Curve (AUC) was used. RESULTS: During the observation period of the study, there was a significant decrease in PMI. This was most evident in patients with surgical therapy in the comparison between diagnosis and after both neoadjuvant therapy and surgery (each p < 0.001). Tumor progression (PD) was not observed significantly more often in the patients with sarcopenia compared to those without sarcopenia at any time point (p = 0.277 to p = 0.465). On average, PD occurred after 271.69 ± 104.20 days. The time from initial diagnosis to PD in patients "with sarcopenia" was not significantly shorter than in patients "without sarcopenia" at any of the time points (p = 0.521 to p = 0.817). The CT radiomics of skeletal muscle could predict both sarcopenia and tumor progression, with the best results for the psoas major muscle using the RF algorithm. For the detection of sarcopenia, the Accuracy was 0.90 ± 0.03 and AUC was 0.96 ± 0.02. For the prediction of PD, the Accuracy was 0.88 ± 0.04 and the AUC was 0.93 ± 0.04. CONCLUSIONS: In the present study, the CT radiomics of skeletal muscle together with machine learning correlated with the presence of sarcopenia, and this can additionally assist in predicting disease progression. These features can be classified as promising alternatives to conventional methods, with great potential for further research and future clinical application. However, when sarcopenia was diagnosed with PMI, no significant correlation between sarcopenia and PD could be observed.

Prehabilitation in an Integrative Medicine Day Clinic for Patients Undergoing Neoadjuvant Treatment: Single-Center Feasibility Pilot Study.

BACKGROUND: Patients with cancer receiving neoadjuvant treatment prior to surgery are in a very stressful situation. Chemotherapy and radiation therapy put a strain on the quality of life and the pending surgery poses a relevant burden for many patients. Preparation of these patients for the intervention in terms of prehabilitation has great potential to reduce the burden of postoperative complications and may improve the clinical outcome. A prehabilitation approach also yields the possibility to address unmet patients' needs and to help them modify their lifestyle in a maintainable way. Therefore, a multimodal approach is mandatory during this critical period. OBJECTIVE: The aim of this study is to assess the feasibility of prehabilitation in an integrative medicine day clinic (PRIME-DC) prior to cancer surgery at a major university clinic. PRIME-DC is considered feasible if 80% of enrolled patients are willing and able to complete at least 6 out of the 8 weekly meetings, each lasting 6.5 hours, at such a clinic. Secondary end points aim to evaluate this multimodal program. METHODS: The PRIME-DC intervention combines mind-body medicine, exercise therapy, nutrition therapy, naturopathic counseling, and the application of a yarrow liver compress. Adult patients with cancer, with a primary tumor in the abdomen (including intraperitoneal cancer, stomach cancer, and extraperitoneal cancers such as pancreatic, bladder, rectal, esophageal, endometrial, ovarian, and cervical cancer) or the breast requiring a neoadjuvant oncological treatment setting are eligible to participate. The addressed cancer entities imply either an extensive surgical intervention with an expected need for prehabilitation (eg, abdominal surgery) or a neoadjuvant treatment of several months with a high burden of treatment-associated side effects (breast cancer). Adherence to the day clinic program is the primary end point being defined as presence during the day clinic session. Secondary end points are physical assessment and quality of life, together with a structured assessment of neoadjuvant treatment-associated side effects. Furthermore, to collect qualitative data voluntary participants of the day clinic will be interviewed in a semistructured way after completion of the day clinic program on each component of the study (mind-body intervention, exercise, nutrition, naturopathic counseling, and a yarrow liver compress). RESULTS: The procedures used in this study adhere to the tenets of the Declaration of Helsinki. As of February 2023, we enrolled 23 patients; the dominant cancer entity is breast cancer (18 enrolled patients). CONCLUSIONS: The presented protocol combines prehabilitation, lifestyle modification, naturopathic counseling, dietary assistance, and naturopathic treatment in an innovative and integrative way. TRIAL REGISTRATION: Deutsches Register Klinischer Studien German Clinical Trials Register DRKS00028126; https://drks.de/search/de/trial/DRKS00028126. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46765.

Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. / Sarkopenie ­ Definition, radiologische Erfassung, klinische Bedeutung.

BACKGROUND: Sarcopenia is an age-related syndrome characterized by a loss of muscle mass and strength. As a result, the independence of the elderly is reduced and the hospitalization rate and mortality increase. The onset of sarcopenia often begins in middle age due to an unbalanced diet or malnutrition in association with a lack of physical activity. This effect is intensified by concomitant diseases such as obesity or metabolic diseases including diabetes mellitus. METHOD: With effective preventative diagnostic procedures and specific therapeutic treatment of sarcopenia, the negative effects on the individual can be reduced and the negative impact on health as well as socioeconomic effects can be prevented. Various diagnostic options are available for this purpose. In addition to basic clinical methods such as measuring muscle strength, sarcopenia can also be detected using imaging techniques like dual X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and sonography. DXA, as a simple and cost-effective method, offers a low-dose option for assessing body composition. With cross-sectional imaging techniques such as CT and MRI, further diagnostic possibilities are available, including MR spectroscopy (MRS) for noninvasive molecular analysis of muscle tissue. CT can also be used in the context of examinations performed for other indications to acquire additional parameters of the skeletal muscles (opportunistic secondary use of CT data), such as abdominal muscle mass (total abdominal muscle area - TAMA) or the psoas as well as the pectoralis muscle index. The importance of sarcopenia is already well studied for patients with various tumor entities and also infections such as SARS-COV2. RESULTS AND CONCLUSION: Sarcopenia will become increasingly important, not least due to demographic changes in the population. In this review, the possibilities for the diagnosis of sarcopenia, the clinical significance, and therapeutic options are described. In particular, CT examinations, which are repeatedly performed on tumor patients, can be used for diagnostics. This opportunistic use can be supported by the use of artificial intelligence. KEY POINTS: · Sarcopenia is an age-related syndrome with loss of muscle mass and strength.. · Early detection and therapy can prevent negative effects of sarcopenia.. · In addition to DEXA, cross-sectional imaging techniques (CT, MRI) are available for diagnostic purposes.. · The use of artificial intelligence (AI) offers further possibilities in sarcopenia diagnostics.. CITATION FORMAT: · Vogele D, Otto S, Sollmann N et al. Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. Fortschr Röntgenstr 2023; 195: 393 - 405.

Is there evidence behind pre- or perioperative cognitive training in gynaecological patients on the prevention of perioperative cognitive dysfunction? A review.

PURPOSE: Perioperative cognitive dysfunction can be observed in all age groups of patients. Sometimes, this is more stressful to the patient than the actual surgical wound. Enhanced recovery after surgery pathways screen for patients at risk and lead to early post-surgical intervention. To prevent cognitive dysfunction, a prehabilitation approach might be useful. METHODS: This systematic literature review provides an overview on the current knowledge on prehabilitation for cognitive dysfunction for gynaecological patients by searching the National Library of Medicine (PubMed) in February 2020 to identify publications regarding presurgical cognitive training with three different search terms. RESULTS: 501 articles were identified and after screening for eligibility five were left for further analysis. Generally, cognitive function is split into several cognitive aspects like anxiety or memory, speed, attention, flexibility or problem-solving functions. Each of these aspects can/need to be trained to show an improvement after general anaesthesia. Training possibilities range from relaxation methods via music, one-on-one personal training sessions to electronically supported training units. CONCLUSION: Prehabilitation of the cognitive function can be split in different cognitive domains. Each of these domains seem to be influenced by training. The training itself can be based on applications or known relaxation methods or even old-fashioned board games. The evidence is, however, still low and there is a need for further studies.

Two-year follow-up after a six-week high-intensity training intervention study with breast cancer patients: physiological, psychological and immunological differences.

PURPOSE: Previously we demonstrated the feasibility of a six-week-long combination of high-intensity interval endurance and strength training (HIT/HIRT) for women with nonmetastatic breast cancer leading to improvements in psychological well-being and performance. Now we report results of a 24-month follow-up. METHODS: Previous intervention (IG, n = 10; 58.7 ± 8.4yrs) and control group (CG, n = 9; 58.8 ± 6.6yrs) were asked for follow-up examinations 12 (T12) and 24 months (T24) after cessation of the supervised training (POST). Medical history, mental well-being, performance and immunological variables were analyzed with respect to intervention start (PRE). RESULTS: IG maximum oxygen consumption (⩒O2peak) 12%-improved POST (p = 0.05) and declined to baseline values T24, while CG ⩒O2peak increased 12% T24 (p = 0.01). IG strength (1RM) increased 31% POST (p < 0.001) and remained above baseline level T24 (p = 0.003), whereas CG 1RM slightly improved T24 (+19%, p = 0.034). IG Anxiety and Depression decreased POST and did not change until T24. IG C-reactive protein decreased POST and increased to pre-exercise levels T24. CG immunological/inflammatory/life quality markers did not change. CONCLUSIONS: Six weeks of HIT/HIRT by breast cancer patients can induce similar beneficial effects like two years of convalescence, but outcomes were unstable and showed a fast backslide in aerobic capacity, activity level and in pro-inflammatory state within 12 months.IMPLICATIONS FOR REHABILITATIONHigh-intensity interval endurance and strength training (HIT/HIRT) for female breast cancer patients was shown to improve psychological well-being and performance, but long-term effects/adherence are unknown.Significant backslides in aerobic capacity, activity level as well as in the pro-inflammatory response after one and two years are observed and should be monitored.Continuous supervision and/or support of breast cancer patients before, during, and after medical care due to poor training adherence when voluntarily executed is recommended.

Multisensory temporal processing in early deaf.

Navigating the world relies on understanding progressive sequences of multisensory events across time. Early deaf (ED) individuals are more precise in visual detection of space and motion than their normal hearing (NH) counterparts. However, whether ED individuals show altered multisensory temporal processing abilities is less clear. According to the connectome model, brain development depends on experience, and therefore the lack of audition may affect how the brain responds to remaining senses and how they are functionally connected. We used a temporal order judgment (TOJ) task to examine multisensory (visuotactile) temporal processing in ED and NH groups. We quantified BOLD responses and functional connectivity (FC) in both groups. ED and NH groups performed similarly for the visuotactile TOJ task. Bilateral posterior superior temporal sulcus (pSTS) BOLD responses during the TOJ task were significantly larger in the ED group than in NH. Using anatomically defined pSTS seeds, our FC analysis revealed stronger somatomotor and weaker visual regional connections in the ED group than in NH during the TOJ task. These results suggest that a lack of auditory input might alter the balance of tactile and visual area FC with pSTS when a multisensory temporal task is involved.

Fishing for (in)continence: long-term follow-up of women with OASIS-still a taboo.

PURPOSE: Obstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life. MATERIAL AND METHODS: Between 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction. RESULTS: A high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire. CONCLUSION: On one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems.

Evaluation of Dry and Wet Formulations of Oxalic Acid, Thymol, and Oregano Oil for Varroa Mite (Acari: Varroidae) Control in Honey Bee (Hymenoptera: Apidae) Colonies.

The efficacy and safety of dry and wet formulations of three nonsynthetic compounds, oxalic acid (OA), thymol (T), and oregano oil (OO), for the control of Varroa destructor Anderson and Trueman infestations in honey bee (Apis mellifera Linnaeus) colonies were determined. The treatments were OA in dust, OA diluted in glycerin solvent embedded in a towel, T in dust, T in glycerin solvent and towel, OO in dry microcapsules, OO in glycerin solvent and towel, and the control. The treatments were applied weekly for 4 wk during the fall season. The rates of acaricide efficacy, weekly mite fall, bee mortality, colony survivorship, and strength, were determined for each of the treatments. All formulations, with the exemption of OO microcapsules, were effective at controlling infestations of V. destructor. The most effective formulations were T dust (96.6%), T glycerin (92.4%), and OA glycerin (79%). More than 85% of the mites were killed during the first 2 wk of treatment with T formulations, compared to less than 30% for the OA glycerin formulation. The lowest efficacy rate was for OO microcapsules (21.3%), and the only treatment that significantly increased bee mortality was OA glycerin. The rates of winter colony survival and honey bee populations were related to the varroacidal efficacy of the formulations. The implications of these findings are discussed.

Beneficial Molecular Adaptations In BRCA-Mutation Carriers By Combined HIT/HIRT Intervention: Results From A Pilot Study.

: Based on growing evidence that breast cancer (BRCA) also plays a pivotal role in the regulation of skeletal muscle metabolism and the response to anti-oxidative stress, we examined the influence of regular exercise in human BRCA mutation carriers on their BRCA1 gene/protein expression and inflammatory/oxidative response. Sixteen BRCA-mutation carriers were assigned to an intervention (IG) or control group (CG). IG received a combination of high-intensity interval endurance (HIT) and strength training (HIRT) for six weeks, whereas CG received a low-intensity activity program. Before (T0) and at the end of the intervention (T1), muscle biopsy, physiological performance, blood withdrawal and anthropometry were obtained. Parameters included: Muscle BRCA1 gene/protein expression, inflammatory/oxidative stress, anti-oxidative capacity, peak oxygen capacity (VO2peak) and 1-repetition maximum (1-RM) at six different training machines. VO2peak and 1-RM of IG were increased at T1 compared to T0, whereas CG performance, physiological and molecular parameters remained unchanged. IG showed increased BRCA1 protein concentration as well as anti-oxidative capacity, whereas gene expression was unaltered. IG inflammatory and oxidative damage did not differ between time points. Combined HIT/HIRT increases aerobic and strength performance of BRCA-mutation carriers with up regulated BRCA1 protein expression and improved anti-oxidative status without showing an increased inflammatory response.

Feasibility and effects of a combined adjuvant high-intensity interval/strength training in breast cancer patients: a single-center pilot study.

PURPOSE: To evaluate feasibility of an exercise intervention consisting of high-intensity interval endurance and strength training in breast cancer patients. METHODS: Twenty-six women with nonmetastatic breast cancer were consecutively assigned to the exercise intervention- (n= 15, mean age 51.9 ± 9.8 years) and the control group (n = 11, mean age 56.9 ± 7.0 years). Cardiopulmonary exercise testing that included lactate sampling, one-repetition maximum tests and a HADS-D questionnaire were used to monitor patients both before and after a supervised six weeks period of either combined high-intensity interval endurance and strength training (intervention group, twice a week) or leisure training (control group). RESULTS: Contrarily to the control group, endurance (mean change of VO2, peak 12.0 ± 13.0%) and strength performance (mean change of cumulative load 25.9 ± 11.2%) and quality of life increased in the intervention group. No training-related adverse events were observed. CONCLUSIONS: Our guided exercise intervention could be used effectively for initiation and improvement of performance capacity and quality of life in breast cancer patients in a relatively short time. This might be especially attractive during medical treatment. Long-term effects have to be evaluated in randomized controlled studies also with a longer follow-up. Implications for Rehabilitation High-intensity interval training allows improvement of aerobic capacity within a comparable short time. Standard leisure training in breast cancer patients is rather suitable for the maintenance of performance capacity and quality of life. Guided high-intensity interval training combined with strength training can be used effectively for the improvement of endurance and strength capacity and also quality of life. After exclusion of contraindications, guided adjuvant high-intensity interval training combined with strength training can be safely used in breast cancer patients.

Prehabilitation in gynecological surgery? What do gynecologists know and need to know.

BACKGROUND/AIMS: The self-quantification of patients is extending beyond the daily routine. More and more patients ask about the 'optimal' physical condition for an elective surgery. As the hysterectomy is one of the most common surgeries, a literature review was conducted to answer the question for the optimal surgical self preparation (prehabilitation). METHODS: A literature review with the search terms 'physical activity' or 'physical exercise' or 'sport' or 'prehabilitation' and 'hysterectomy' was conducted in the National Library of Medicine database (PubMed) and Web of science. The search was limited to English or German language and publishing date after 2000. Two independent researchers (SO, FE) reviewed the results and excluded irrelevant or double articles. RESULTS: After excluding irrelevant articles, five publications were left for review. One article published a study protocol and one a case report. Three articles reported study results. The numbers of patients reported are low. Prehabilitation programs differ depending on the primary study outcome. There seems to be a benefit for earlier discharge if patients undergo prehabilitation. CONCLUSION: Unlike other disciplines where prehabilitation has been studied, a gynecologic viewpoint still needs establishing and further studies are needed to clarify the benefit for the patients.

IL-4 mRNA Is Downregulated in the Liver of Pancreatic Cancer Patients Suffering from Cachexia.

BACKGROUND: Interleukin-4 (IL-4) together with interleukin-13 (IL-13) play an important role in inflammation and wound repair, and are known to be upregulated in human skeletal muscle after strenuous physical exercise. Additionally, these cytokines may act as autocrine growth factors in pancreatic cancer cells. We hypothesize that IL-4, IL-13, and their corresponding receptors are involved in mechanism of cancer cachexia. METHODS: Tissue samples from human skeletal muscle, white fat, liver, healthy pancreas, and pancreatic ductal adenocarcinoma were analyzed by quantitative real-time polymerase chain reaction for mRNA expression levels of IL-4, IL-13, IL-4 receptor α, and IL-13 receptor α1. RESULTS: We demonstrate for the first time that liver IL-4 mRNA is downregulated in vivo in patients with pancreatic cancer and cachexia. Additionally, IL-4 mRNA in the liver inversely correlated with musculus psoas thickness. CONCLUSION: We speculate that suppression of IL-4 is involved in cancer cachexia, although the exact mechanisms have to be further elucidated.

O Tumblr e sua relação com práticas autodestrutivas: o caráter epidemico da autolesão / Tumblr and self-destructive practices: the epidemic character of self-harm / El Tumblr y su relación con las prácticas autodestructivas: el carácter epidémico de la autolesión

Notícias sobre adolescentes que ferem a si mesmos propositalmente têm se tornado cada vez mais comuns na mídia e nas redes sociais. Além disso, pesquisas têm demonstrado a relação entre a disseminação da prática de autolesão com as trocas que ocorrem em páginas da internet (Morey, Eagle, Verne & Cook, 2011; Whitlock, 2009; Whitlock, Powers & Eckenrode, 2006). Destaca-se, nesse sentido, a plataforma blogging Tumblr. Considerando essa circulação, o objetivo deste trabalho foi o de compreender se a utilização da plataforma blogging Tumblr possuía influência na disseminação do conteúdo e prática da autolesão entre adolescentes. Nossa análise discursiva demonstrou que essa plataforma blogging se constitui como um espaço em que adolescentes podem compartilhar seu sofrimento e falar sobre a autolesão sem serem julgados. No que se refere ao Tumblr, é possível corroborar com estudos desenvolvidos em outros países quanto ao caráter epidêmico da autolesão, uma vez que a identificação com o sofrimento de pessoas que se autolesionam pode ser um fator de risco para começar. Os resultados desta pesquisa buscam dar visibi- lidade para esse problema que afeta as pessoas para além do espaço virtual.

News items about teenagers who hurt themselves on purpose have become increasingly common in the media and social networks. Research in other countries has been demonstrating that there is a relationship between the spread of the practice of self-injury and the use of websites and blogs on the Internet (Morey, Eagle, Verne & Cook, 2011; Whitlock, 2009; Whitlock, Powers &Eckenrode, 2006). For this reason, the objective of this study was to understand if the Tumblr blogging platform exerts influence on the dissemination of the content and practice of self-harm among adolescents. Our discursive analysis has shown that this blogging platform constitutes a space where teens can share their suffering and talk about self-harm without judgment. Moreover, identification with the suffering of people who self-harm might be a risk factor to begin with. The results of this research seek to give visibility to this problem that affects people beyond the virtual realm.

Noticias sobre adolescentes que se hieren a sí mismos intencionalmente se han vuelto cada vez más común en los medios de comunicación y las redes sociales. Además, algunas investigaciones apuntan a la relación entre la propagación de la práctica de autolesionarse con el uso de páginas y blogs en internet (Morey,Eagle, Verne & Cook, 2011; Whitlock, 2009;Whitlock,Powers&Eckenrode, 2006). Es importante resaltar, que por ese motivo el objetivo de este trabajo fue comprender si el uso de la plataforma blogging / Tumblr influye en la propagación del contenido y de la práctica de autolesión entre adolescentes. El análisis discursivo mostró que la plataforma blogging se constituye como un espacio en el que los adolescentes pueden compartir su sufrimiento y hablar sobre la autolesión sin ser juzgados. En cuanto al Tumblr, es posible corroborar con investigaciones desarrolladas en otros países sobre el carácter epidémico de la autolesión, ya que la identificación con el sufrimiento de las personas que se autolesionan puede ser un factor de riesgo para empezar a autolesionarse. Los resultados de la presente investigación intentan dar visibilidad a este problema dado que afecta a las personas más allá del espacio virtual.

O Tumblr e sua relação com práticas autodestrutivas:o caráter epidemico da autolesão / Tumblr and self-destructive practices: the epidemic character of self-harm / El Tumblr y su relación con las prácticas autodestructivas: el carácter epidémico de la autolesión

Notícias sobre adolescentes que ferem a si mesmos propositalmente têm se tornado cada vez mais comuns na mídia e nas redes sociais. Além disso, pesquisas têm demonstrado a relação entre a disseminação da prática de autolesão com as trocas que ocorrem em páginas da internet (Morey, Eagle, Verne & Cook, 2011; Whitlock, 2009; Whitlock, Powers & Eckenrode, 2006). Destaca-se, nesse sentido, a plataforma blogging Tumblr. Considerando essa circulação, o objetivo deste trabalho foi o de compreender se a utilização da plataforma blogging Tumblr possuía influência na disseminação do conteúdo e prática da autolesão entre adolescentes. Nossa análise discursiva demonstrou que essa plataforma blogging se constitui como um espaço em que adolescentes podem compartilhar seu sofrimento e falar sobre a autolesão sem serem julgados. No que se refere ao Tumblr, é possível corroborar com estudos desenvolvidos em outros países quanto ao caráter epidêmico da autolesão, uma vez que a identificação com o sofrimento de pessoas que se autolesionam pode ser um fator de risco para começar. Os resultados desta pesquisa buscam dar visibilidade para esse problema que afeta as pessoas para além do espaço virtual.(AU)

News items about teenagers who hurt themselves on purpose have become increasingly common in the media and social networks. Research in other countries has been demonstrating that there is a relationship between the spread of the practice of self-injury and the use of websites and blogs on the Internet (Morey, Eagle, Verne & Cook, 2011; Whitlock, 2009; Whitlock, Powers & Eckenrode, 2006). For this reason, the objective of this study was to understand if the Tumblr blogging platform exerts influence on the dissemination of the content and practice of self-harm among adolescents. Our discursive analysis has shown that this blogging platform constitutes a space where teens can share their suffering and talk about self-harm without judgment. Moreover, identification with the suffering of people who self-harm might be a risk factor to begin with. The results of this research seek to give visibility to this problem that affects people beyond the virtual realm.(AU)

Noticias sobre adolescentes que se hieren a sí mismos intencionalmente se han vuelto cada vez más común en los medios de comunicación y las redes sociales. Además, algunas investigaciones apuntan a la relación entre la propagación de la práctica de autolesionarse con el uso de páginas y blogs en internet (Morey,Eagle, Verne & Cook, 2011; Whitlock, 2009;Whitlock, Powers&Eckenrode, 2006). Es importante resaltar, que por ese motivo el objetivo de este trabajo fue comprender si el uso de la plataformablogging / Tumblr influye en la propagación del contenido y de la práctica deautolesión entre adolescentes. El análisis discursivo mostró que la plataforma blogging se constituye como un espacio en el que los adolescentes pueden compartir su sufrimiento y hablar sobre la autolesión sin ser juzgados. En cuanto al Tumblr, es posible corroborar con investigaciones desarrolladas en otros países sobre el carácter epidémico de la autolesión, ya que la identificación con el sufrimiento de las personas que se autolesionan puede ser un factor de riesgo para empezar a autolesionarse. Los resultados de la presente investigación intentan dar visibilidad a este problema dado que afecta a las personas más allá del espacio virtual.(AU)

Step Counter Use and Sedentary Time in Adults: A Meta-Analysis.

Although step counters are increasingly being used in walking programmes to promote sedentary behavior changes in adults, their effectiveness remains unknown. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the effectiveness of step counter use in reducing sedentary time among adults.English-language RCTs from 3 databases were searched up to December 2014. Studies were included if they evaluated the effects of step counter use in adult populations and reported outcomes in sedentary time. Summary estimates (Cohen d with 95% confidence intervals [CIs]) were pooled using a random-effects model. Subgroup analyses and random-effects meta-regression analyses based on the characteristics of participants or interventions were conducted to explore their associations with sedentary time changes.Fifteen RCTs with a total sample size of 3262 adults were included. Step counter use was associated with a small but significant overall effect in reducing sedentary time (d = -0.20, 95% CI -0.33 to -0.07), equating to a reduction in sedentary time of ~23 min/d compared with controls. Subgroup analyses showed that step counter use with a step goal was associated with significantly reduced sedentary time (d =- 0.32, 95% CI -0.53 to -0.11), whereas without, it had only a trend. A greater reduction in sedentary time was observed among step counter users employing objective methods than those employing subjective methods for measurement (P = 0.03). Effects of covariates on sedentary time changes were generally unclear.Step counter use is associated with reduced sedentary time among adults. Future studies are required to specify the step goal use and to employ objective as well as subjective methods for measuring both total and domain-specific sedentary time.

Combined esophageal multichannel intraluminal impedance and pH monitoring after repair of esophageal atresia.

OBJECTIVE: Gastroesophageal reflux disease and impaired esophageal motility is a frequent problem after repair of esophageal atresia (EA). Combined multichannel intraluminal impedance (MII) and pH measurement identifies acidic and weakly acidic esophageal bolus movements. Our aim was to evaluate gastroesophageal reflux and its association with gastrointestinal or extraintestinal symptoms using combined MII-pH measurement. PATIENTS AND METHODS: In all, 24 patients (4 months-23 years; 17 male, 7 female) with repaired EA were included in this study. A single catheter with 6 impedance channels and 1 pH channel was used to perform the 24-hour MII-pH study. Symptoms were recorded during the study as events and with a standardized questionnaire. In a subgroup of patients, an impedance swallowing test evaluating liquid and viscous bolus movements was performed. RESULTS: We detected a total of 911 episodes of retrograde bolus movement, 379 acidic and 532 weakly acidic bolus movements. In all, 201 symptom events were recorded. Of these events, 42% were associated with retrograde bolus movements. More symptom events were associated with weakly acidic reflux (26%) than with acid reflux episodes (16%). There was a poor correlation between symptoms and MII-pH study findings. In comparison with patients without esophageal surgery, EA patients showed significantly fewer complete swallows of liquid (42% vs 98%) and viscous material (18% vs 87%). CONCLUSIONS: In patients with corrected EA, half of the reflux events could be detected only by MII. We also demonstrated that weakly acidic reflux can be responsible for the patients' symptoms. However, patients may have few or no symptoms despite poor esophageal function and extensive gastroesophageal reflux disease.