Dose-response effects of resistance training on physical function in frail older Chinese adults: A randomized controlled trial.

BACKGROUND: Effective exercise for the frail elderly has been found to contribute to healthy aging; the corresponding relationship between intensity and volume of exercise and health effects remains unclear. The present study aimed to investigate the dose-response effects of resistance training on muscle strength and physical fitness in frail older adults. METHODS: In this randomized controlled trial, participants were randomized into seven groups: moderate-volume low-intensity, moderate-volume moderate-intensity, moderate-volume high-intensity, high-volume low-intensity, high-volume moderate-intensity, high-volume high-intensity and routine care, receiving 12 weeks of resistance training of different intensities and volumes of exercise. The outcomes were muscle strength (assessed by ergonomics force gauges) and physical fitness function (assessed by the 6-min walking test [6MWT], the 30-s sit-to-stand test [30sSTST] and the 8-foot up-and-go test [8-FUGT]) before and at 6 and 12 weeks of intervention. RESULTS: A total of 161 participants completed the exercise intervention. There were no significant differences in age, sex, height, body weight and body mass index among the seven groups. The exercise volume of resistance training showed linear relationships with muscle strength of the lower limbs, 30sSTST and 6MWT results and a non-linear relationship with 8-FUGT. Resistance training intensity was found to have a linear relationship with muscle strength of the lower limbs and 6MWT and non-linear relationships with 30sSTST and 8-FUGT. The mixed linear model analysis revealed that the lower limb muscle strength differed significantly before and during the intervention (W = 8571.5, Padj  < 0.001), before and after the intervention (W = 6968, Padj  = 0.001) and during and after the intervention (W = 2834.5, Padj  < 0.001); that the 6MWT performance differed during and after the intervention (W = 3184, Padj  < 0.001); and that the 30sSTST was different between before and during the intervention (W = 2350.5, Padj  = 0.012) and between during and after the intervention (W = 2290.5, Padj  = 0.045). CONCLUSIONS: Resistance training was found to be associated with muscle strength and physical fitness in frail older adults in a dose-dependent manner. High-intensity resistance training could be more effective for improving the muscle strength of frail older adults, and the improvement of 6MWT performance was even higher. High-volume resistance training significantly improved muscle strength, with even greater improvement in the 30sSTST and 6MWT performances. Both the intensity and volume of exercise were found to greatly value physical function in frail older adults. Low-moderate-intensity resistance training and low-moderate-volume resistance training also had some advantages in terms of safety, efficacy and acceptance in elderly with frailty.

Network meta-analysis of comparative efficacy of animal-assisted therapy vs. pet-robot therapy in the management of dementia.

Objective: This network meta-analysis aimed to compare and rank the efficacy of animal-assisted therapy (AAT) and pet-robotic therapy (PRT) in the management of dementia. Methods: Relevant studies were identified by searching PubMed, EMBASE, the Cochrane Library, SCOPUS, and Web of Science (WoS) until October 13, 2022. Traditional meta-analysis was first conducted based on the random-effects model, then random network meta-analysis was conducted to determine the relative efficacy and rank probability of AAT and PRT. Results: Nineteen randomized controlled trials (RCTs) were included in this network meta-analysis. Network meta-analysis revealed that PRT marginally benefited agitation alleviation compared with control (standard mean difference [SMD]: -0.37, 95% confidence interval [95%CI]: -0.72 to -0.01) although both AAT and PRT did not improve cognitive function, reduce depression, and improve Quality of Life (QoL). The SUCRA probabilities indicated that PRT ranked better than AAT in agitation, cognitive function, and QoL, although there were no differences between the two therapies. Conclusion: The present network meta-analysis reveals that PRT may help alleviate agitated behaviors in people with dementia. However, future studies are warranted to establish evidence of the effectiveness of PRT and further evaluate the differences between different robot types in managing dementia.

Prognostic Index for Nonsmall Cell Lung Cancer Based on Immune-Related Genes Expression.

Immune system dysregulation is associated with tumor incidence and growth. Here, we established an RNA-based individualized immune signature associated with prognosis for nonsmall cell lung cancer (NSCLC) to guide adjuvant therapy. We downloaded publicly accessible data on RNA expression and clinical characteristics of NSCLC from the Cancer Genome Atlas (TCGA). From immune-related genes (IRGs) retrieved from the immunology database and analysis portal (ImmPort) database, we then screened differentially expressed immune-related genes (DEIRGs). Using overall survival (OS) as a clinical endpoint, we identified 26 prognostic DEIRGs via univariate and multivariate Cox regression analysis, and then developed a risk model based on these 26 IRGs with an area under the curve (AUC) of 0.701, and its predictive ability independent from other clinical factors. We also downloaded tumor immune infiltrate data and analyzed the correlations between lymphocytic infiltration with our risk scores, but found no significant association. Furthermore, we retrieved 86 differentially expressed transcription factors (TFs) to assess their regulatory relationships with the 26 prognostic DEIRGs. In summary, we developed a robust risk model to predict survival in patients with NSCLC, based on the expression of 26 IRGs. It provides novel predictive and therapeutic molecular targets.

Feasibility Study on Predicting Recurrence Risk of Bladder Cancer Based on Radiomics Features of Multiphase CT Images.

Background: Predicting the recurrence risk of bladder cancer is crucial for the individualized clinical treatment of patients with bladder cancer. Objective: To explore the radiomics based on multiphase CT images combined with clinical risk factors, and to further construct a radiomics-clinical model to predict the recurrence risk of bladder cancer within 2 years after surgery. Methods: Patients with bladder cancer who underwent surgical treatment at the First Affiliated Hospital of Soochow University from January 2016 to December 2019 were retrospectively included and followed up to record the disease recurrence. A total of 183 patients were included in the study, and they were randomly divided into training group and validation group in a ratio of 7: 3. The three basic models which are plain scan, corticomedullary phase, and nephrographic phase as well as two combination models, namely, corticomedullary phase + nephrographic phase and plain scan + corticomedullary phase + nephrographic phase, were built with the logistic regression algorithm, and we selected the model with higher performance and calculated the Rad-score (radiomics score) of each patient. The clinical risk factors and Rad-score were screened by Cox univariate and multivariate proportional hazard models in turn to obtain the independent risk factors, then the radiomics-clinical model was constructed, and their performance was evaluated. Results: Of the 183 patients included, 128 patients constituted the training group and 55 patients constituted the validation group. In terms of the radiomics-clinical model constructed by three independent risk factors-number of tumors, tumor grade, and Rad-score-the AUCs of the training group and validation group were 0.813 (95% CI 0.740-0.886) and 0.838 (95% CI 0.733-0.943), respectively. In the validation group, the diagnostic accuracy, sensitivity, and specificity were 0.727, 0.739, and 0.719, respectively. Conclusion: Combining with radiomics based on multiphase CT images and clinical risk factors, the radiomics-clinical model constructed to predict the recurrence risk of bladder cancer within 2 years after surgery had a good performance.

An Optimal Animal Model of Ischemic Stroke Established by Digital Subtraction Angiography-Guided Autologous Thrombi in Cynomolgus Monkeys.

Objective: Ischemic stroke seriously threatens human health, characterized by the high rates of incidence, disability, and death. Developing a reliable animal model that mimics most of the features of stroke is critical for pathological studies and clinical research. In this study, we aimed to establish and examine a model of middle cerebral artery occlusion (MCAO) guided by digital subtraction angiography (DSA) in cynomolgus monkeys. Materials and Methods: In this study, 15 adult male cynomolgus monkeys were enrolled. Under the guidance of DSA, a MCAO model was established by injecting an autologous venous clot into the middle cerebral artery (MCA) via femoral artery catheter. Thrombolytic therapy with alteplase (rt-PA) was given to eight of these monkeys at 3 h after the occlusion. Blood test and imaging examination, such as computed tomography angiography (CTA), CT perfusion (CTP), brain magnetic resonance imaging (MRI), and brain magnetic resonance angiography (MRA), were performed after the operation to identify the post-infarction changes. The behavioral performance of cynomolgus monkeys was continuously observed for 7 days after operation. The animals were eunthanized on the 8th day after operation, and then the brain tissues of monkeys were taken for triphenyltetrazolium chloride (TTC) staining. Results: Among the 15 cynomolgus monkeys, 12 of them were successfully modeled, as confirmed by the imaging findings and staining assessment. One monkey died of brain hernia resulted from intracranial hemorrhage confirmed by necropsy. DSA, CTA, and MRA indicated the presence of an arterial occlusion. CTP and MRI showed acute focal cerebral ischemia. TTC staining revealed infarct lesions formed in the brain tissues. Conclusion: Our study may provide an optimal non-human primate model for an in-depth study of the pathogenesis and treatment of focal cerebral ischemia.

Preoperative Prediction Power of Radiomics for Breast Cancer: A Systemic Review and Meta-Analysis.

Background: To evaluate the preoperative predictive value of radiomics in the diagnosis of breast cancer (BC). Methods: By searching PubMed and Embase libraries, our study identified 19 eligible studies. We conducted a meta-analysis to assess the differential value in the preoperative assessment of BC using radiomics methods. Results: Nineteen radiomics studies focusing on the diagnostic efficacy of BC and involving 5865 patients were enrolled. The integrated sensitivity and specificity were 0.84 (95% CI: 0.80-0.87, I 2 = 76.44%) and 0.83 (95% CI: 0.78-0.87, I 2 = 81.79%), respectively. The AUC based on the SROC curve was 0.91, indicating a high diagnostic value. Conclusion: Radiomics has shown excellent diagnostic performance in the preoperative prediction of BC and is expected to be a promising method in clinical practice.

Effects of lower limb resistance exercise on muscle strength, physical fitness, and metabolism in pre-frail elderly patients: a randomized controlled trial.

BACKGROUND: Few studies examined interventions in frail elderly in China, while the awareness of applying interventions to prevent frailty in pre-frail elderly is still lacking. This study aimed to explore the effects of lower limb resistance exercise in pre-frail elderly in China. METHODS: This was a randomized controlled trial of patients with pre-frailty. The control group received routine care, while the exercise group received a 12-week lower limb resistance exercise based on routine care. The muscle strength in the lower limbs, physical fitness, and energy metabolism of the patients was evaluated at admission and after 12 weeks of intervention. RESULTS: A total of 60 pre-frail elderly were included in this study. The patients were divided into the exercise group (n = 30) and control group (n = 30) by random grouping. There were 17 men and 13 women aged 65.3 ± 13.4 in the exercise group, and 15 men and 15 women aged 67.6 ± 11.9 years in the control groups. The Barthel index was 80.3 ± 10.6 and 85.1 ± 11.6, respectively. The characteristics of the two groups were not significantly different before intervention (all p > 0.05). The results of repeated measurement ANOVA showed that there was statistically significant in crossover effect of group * time (all p < 0.05), that is, the differences of quadriceps femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft "up & go" test, daily activity energy expenditure and metabolic equivalent between the intervention group and the control group changed with time, and the variation ranges were different. The main effects of time were statistically significant (all p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, 8-ft "up & go" test, daily activity energy expenditure and metabolic equivalent of the intervention group and the control group were significantly different before and after intervention. The main effects of groups were statistically significant (p < 0.05), namely, femoris muscle strength, 6-min walking test, 30-s sit-to-stand test, daily activity energy expenditure and metabolic equivalent before and after intervention were significantly different between the intervention group and the control group, while there was no significant differences in 8-ft "up & go" test between groups. CONCLUSION: Lower limb resistance exercise used for the frailty intervention could improve muscle strength, physical fitness, and metabolism in pre-frail elderly. TRIAL REGISTRATION: ChiCTR, ChiCTR2000031099. Registered 22 March 2020, http://www.chictr.org.cn/edit.aspx?pid=51221&htm=4.

Immunotherapy-induced pneumonitis in non-small cell lung cancer patients: current concern in treatment with immune-check-point inhibitors.

Purpose Immune-related adverse events (IrAEs) are auto-immune reactions associated with immune checkpoint inhibitor-based therapy (ICI). To date, little is known about immunotherapy-induced pneumonitis (IIP). In this study, we investigated the clinical and CT features of IIP in non-small cell lung cancer (NSCLC) patients treated with ICI. Methods CT images and clinical data of 98 NSCLC patients in our hospital were retrospectively analyzed after ICI therapy, and the incidence, onset time, CT findings, grade, treatment and prognosis of IIP were recorded. Results Nineteen patients developed IIP, which occurred 42∼210 days after ICI therapy, and the median time was 97 days. The CT findings for IIP showed multifocal ground-glass opacity (GGO) in 5 cases, patchy shadows in 6 cases, mixed distribution of patchy and strip-like shadows in 4 cases, and patchy shadows with honeycomb lung in 4 cases. The mean age and proportions of smokers, CD3+ and CD4+ of T lymphocyte subset in patients with IIP were significantly higher than those in patients without IIP (all p < 0.05). Among 19 patients with IIP, there were 10 patients with grade 1 ~ 2 and 9 patients with grade 3 ~ 4; 13 patients received hormone therapy, 12 of them were improved or stable, and 1 patient got worse after hormone therapy. No deaths from IIP were found. Conclusion IIP is a relatively rare but serious adverse event, and it is sensitive to hormone therapy. Its CT manifestations are diverse, and timely detection and treatment are the keys to reduce IIP.

Reliability and Validity of the Chinese Mandarin Version of the Swallowing Quality of Life Questionnaire.

Swallowing disorders can adversely affect quality of life (QOL). To develop the Chinese version of the Swallowing Quality of Life Questionnaire (ChSWAL-QOL) and evaluate its reliability and validity, the ChSWAL-QOL was generated by forward translation of the original SWAL-QOL, backward translation, cultural adaptation, and revision using the Delphi method. The ChSWAL-QOL was administered to 376 patients with dysphagia treated at Peking Union Medical College Hospital between November 1, 2017 and December 31, 2018. Reliability was evaluated using Cronbach's α and test-retest reliability. Content validity was assessed using the content validity index (CVI). Structural validity was evaluated by exploratory factor and confirmatory factor analyses. The 44-item, 11-dimension of ChSWAL-QOL was considered semantically relevant, clearly expressed and easy to understand in a preliminary study. The final analysis included 360 of 376 questionnaires (95.7%). Cronbach's α was 0.906 for the whole scale and ranged from 0.815 to 1.000 for the individual dimensions, and the test-retest reliability was 0.847, indicating that the ChSWAL-QOL had excellent internal consistency. CVI was 0.964 overall and ranged from 0.870 to 1.000 for the individual dimensions. Exploratory factor analysis identified a dysphagia-related component (psychological burden, feeding duration, swallowing symptoms, eating desire, communication, feeding fear, mental health, and social function) and a generic component (fatigue and sleep) explaining 52.8% and 10.8% of the variance, respectively. The ChSWAL-QOL has excellent reliability and validity. This scale could be used as a tool to assess the QOL of patients with dysphagia in mainland China.

Nutritional status of Chinese oldest-old adults (≥80 years of age): a cross-sectional study in Beijing.

BACKGROUND: Nutrition is associated with frailty, functional impairments, and mortality in elderly people. Only a few studies focused on oldest-old hospitalized patients with worse health and more comorbidities compared with the general older adults in China. OBJECTIVE: This study aimed to investigate the nutritional risk, malnutrition, and nutritional support status of oldest-old hospitalized patients (≥80 years of age) in China, and to provide a basis for implementing an effective nutritional intervention. METHODS: This study involved 358 oldest-old patients of Peking Union Medical College Hospital in China. The Nutrition Risk Screening 2002 scale was used to assess nutritional risk. Malnutrition was defined as body mass index (BMI) < 18.5 kg/m2; or unwanted weight loss >10% at any time, or unwanted weight loss >5% in recent 3 months and BMI < 22 kg/m2. Logistic regression analysis was used to identify factors associated with nutritional risk. RESULTS: The overall frequency of nutritional risk and malnutrition was 50.3% (180/358) and 36.0% (129/358), respectively. Also, 134 (37.3%) patients received nutritional support; the ratio of parenteral nutrition (PN) to enteral nutrition (EN) was 1.35:1. Further, 106 (58.9%) patients with nutritional risk received nutritional support. The number of chronic diseases and age were protective factors, and activities of daily living (ADL) were risk factors. CONCLUSIONS: The overall frequencies of nutritional risk and malnutrition of oldest-old hospitalized patients were high, and the rates of EN and PN were low. Nutritional risk was associated with the number of chronic diseases, age, and ADL.

A new solution model for cardiac medical image segmentation.

BACKGROUND: Calculation methods have a critical role in the precise sorting of medical images. Particle swarm optimization (PSO) is a widely used approach in the clinical centers and for other medical applications as it can disentangle optimization errors in attached spaces. In this work, a new model for image segmentation is proposed through an improved optimization algorithm. METHODS: A novel multi-objective algorithm was configured, named "multi-objective mathematical programming" (MOMP), based on the normalized normal constraint method (NNCM). In this model, the proposed algorithm was applied to evaluate the robustness of the suggested model through including the synthetic images of objects with various concavities and Gaussian noise. This model segments the individuals' heart and the left ventricle from data sets of sequentially evaluated tomography and magnetic resonance images. To objectively and quantifiably assess the presentation of the medical image segmentations based on regions outlined by experts and the graph cut method, a set of distance and resemblance metrics were implemented. RESULTS: The numerical results obtained in experimental test cases demonstrate the validity and superiority of the proposed model through better segmentation accuracy and stability. CONCLUSIONS: The results indicated that the proposed MOMP method can outperform all traditional models in terms of segmentation accuracy and stability, and is thus appropriate for use in medical imaging.