Search Results (113)

This study aimed to investigate the effects of inspiratory muscle training (IMT) on inspiratory muscle strength, dyspnea, and quality of life (QOL) in COPD patients. A comprehensive search was undertaken on the Web of Science, Scopus, Embase, Cochrane, and PubMed databases, encompassing data published up to 31 March 2024. A meta-analysis was subsequently conducted to quantify the standardized mean difference (SMD) and 95% confidence interval (CI) for the effects of IMT in COPD patients. Sixteen studies met the inclusion criteria. IMT significantly improved inspiratory muscle strength (SMD, 0.86, p < 0.00001), dyspnea (SMD = −0.50, p < 0.00001), and QOL (SMD = 0.48, p = 0.0006). Subgroup analysis showed that <60% maximal inspiratory muscle pressure (PImax) IMT (inspiratory muscle strength, SMD = 1.22, p = 0.005; dyspnea, SMD = −0.92, p < 0.0001), IMT conducted for ≤20 min (inspiratory muscle strength, SMD = 0.97, p = 0.008; dyspnea, SMD = −0.63, p = 0.007; QOL, SMD = 1.66, p = 0.007), and IMT conducted >3 times per week (inspiratory muscle strength, SMD = 1.06, p < 0.00001; dyspnea, SMD = −0.54, p < 0.00001; QOL, SMD = 0.48, p = 0.0009) had greater effects. This meta-analysis provides clinicians with evidence supporting the recommendation that COPD patients engage in IMT at <60% PImax for more than 3 times per week, with each session lasting no more than 20 min, to improve inspiratory muscle strength, dyspnea, and QOL. Full article

Background: Manual therapy (MT) and occlusal splint therapy (OST) are the most conservative therapies applied on patients with temporomandibular disorders (TMDs). The aim was to compare the efficacy of MT vs. OST in improving pain, maximal mouth opening (MMO), disability, and health related-quality of life (hr-QoL) in these patients. Methods: According to PRISMA guidelines, a meta-analysis (CRD42022343915) was conducted including randomized controlled trials comparing the effectiveness of MT vs. OST in TMD patients, after searching in PubMed, PEDro, SCOPUS, and WOS up to March 2024. Methodological quality and risk of bias were assessed using the PEDro Scale. Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI) were the pooled effect measures calculated. Results: Nine studies, providing data from 426 patients, were included. Meta-analyses revealed that MT is more effective than OST in reducing disability (SMD = −0.81; 95% CI −1.1 to −0.54) and increasing MMO (SMD = 0.52; 95% CI 0.27 to 0.76) without differences for improving pain intensity and hr-QoL. Subgroup analyses revealed the major efficacy of OST in reducing pain in myogenic patients (SMD = 0.65; 95% CI 0.02 to 1.28). Conclusions: With caution, due to the low number of studies included, MT may be more effective than OST for improving disability and MMO in patients with TMDs. Full article

Team sports require athletes’ exceptional perceptual-cognitive skills, such as anticipation and decision-making. Perceptual-cognitive training in laboratories aims to enhance these abilities. However, its effectiveness in real-game performance remains controversial, necessitating a systematic review and meta-analysis to determine optimal training methods. Following the PRISMA guidelines, we searched databases (e.g., PubMed, WOS, Scopus, and EBSCO) for relevant studies published before November 2023, assessed study quality, extracted important characteristics, and conducted a meta-analysis using Stata 15.1. This study was registered in PROSPERO (CRD42023494324). A total of 22 quantitative studies involving 45 effect sizes were included. Perceptual-cognitive training positively influenced elite athletes’ anticipation and decision-making. However, its transfer effect on real-game performance improvement (ES = 0.65) was inferior to laboratory performance improvement (ES = 1.51). Sub-group analyses indicated that the effects of training interventions varied based on stimulus presentation and intervention duration. Based on our findings, we concluded that while perceptual-cognitive training improved on-court performance, its transfer effects were limited. To maximize effectiveness, future interventions should use virtual reality to present training stimuli and incorporate participants’ sport-specific responses to reflect real-game scenarios. Full article

Current guidelines advocate for the use of prophylactic implantable cardioverter defibrillators (ICDs) for all patients with symptomatic heart failure (HF) with low ejection fraction (EF). As many patients will never use their device and some are prone to device-related complications, scoring systems for delineating subgroups with differential ICD survival benefits are crucial to maximize ICD benefit and mitigate complications. This review summarizes the main scores, including MADIT trial-based Risk Stratification Score (MRSS) and Seattle Heart Failure Model (SHFM), which are based on randomized trials with a control group (HF medication only) and validated on large cohorts of ‘real-world’ HF patients. Recent studies using cardiac MRI (CMR) to predict ventricular arrhythmia (VA) are mentioned as well. The review shows that most scores could not delineate sustained VA incidence, but rather mortality without prior appropriate ICD therapies. Multiple scores could identify high-risk subgroups with extremely high probability of early mortality after ICD implant. On the other hand, low-risk subgroups were defined, in whom a high ratio of appropriate ICD therapy versus death without prior appropriate ICD therapy was found, suggesting significant ICD survival benefit. Moreover, MRSS and SHFM proved actual ICD survival benefit in low- and medium-risk subgroups when compared with control patients, and no benefit in high-risk subgroups, consisting of 16–20% of all ICD candidates. CMR reliably identified areas of myocardial scar and ‘channels’, significantly associated with VA. We conclude that as for today, multiple scoring models could delineate patient subgroups that would benefit differently from prophylactic ICD. Due to their modest-moderate predictability, these scores are still not ready to be implemented into clinical guidelines, but could aid decision regarding prophylactic ICD in borderline cases, as elderly patients and those with multiple co-morbidities. CMR is a promising technique which might help delineate patients with a low- versus high-risk for future VA, beyond EF alone. Lastly, genetic analysis could identify specific mutations in a non-negligible percent of patients, and a few of these mutations were found to predict an increased arrhythmic risk. Full article

Mucopolysaccharidosis type II (MPS II; Hunter syndrome) is a rare, X-linked disorder caused by deficient activity of the enzyme iduronate-2-sulfatase. Signs and symptoms typically emerge at 1.5–4 years of age and may include cognitive impairment, depending on whether patients have the neuronopathic or non-neuronopathic form of the disease. Treatment is available in the form of enzyme replacement therapy (ERT) with recombinant iduronate-2-sulfatase (idursulfase). A systematic literature review was conducted to assess the evidence regarding efficacy, effectiveness, and safety of ERT with intravenous idursulfase for MPS II. Electronic databases were searched in January 2023, and 33 eligible articles were found. These were analyzed to evaluate the effects of intravenous idursulfase and the overall benefits and disadvantages in patient subgroups. Studies showed that intravenous idursulfase treatment resulted in improved short- and long-term clinical and patient-centered outcomes, accompanied by a favorable safety profile. Patients with non-neuronopathic MPS II had more pronounced improvements in clinical outcomes than those with neuronopathic MPS II. In addition, the review identified that improvements in clinical outcomes are particularly apparent if intravenous idursulfase is started early in life, strengthening previous recommendations for early ERT initiation to maximally benefit patients. This review provides a comprehensive summary of our current knowledge on the efficacy of ERT in different populations of patients with MPS II and will help to inform the overall management of the disease in an evolving treatment landscape. Full article

Autism spectrum disorder (ASD) is associated with multiple physiological abnormalities. Current laboratory and clinical evidence most commonly report mitochondrial dysfunction, oxidative stress, and immunological imbalance in almost every cell type of the body. The present work aims to evaluate oxygen consumption rate (OCR), extracellular acidification rate (ECAR), and inflammation-related molecules such as Cyclooxygenase-2 (COX-2), chitinase 3-like protein 1 (YKL-40), Interleukin-1 beta (IL-1β), Interleukin-9 (IL-9) in ASD children with and without regression compared to healthy controls. Children with ASD (n = 56) and typically developing children (TDC, n = 12) aged 1.11 to 11 years were studied. Mitochondrial activity was examined in peripheral blood mononuclear cells (PBMCs) isolated from children with ASD and from the control group, using a metabolic analyzer. Gene and protein levels of IL-1β, IL-9, COX-2, and YKL-40 were investigated in parallel. Our results showed that PBMCs of the ASD subgroup of regressed patients (ASD R(+), n = 21) had a specific pattern of mitochondrial activity with significantly increased maximal respiration, respiratory spare capacity, and proton leak compared to the non-regressed group (ASD R(-), n = 35) and TDC. Furthermore, we found an imbalance in the studied proinflammatory molecules and increased levels in ASD R(-) proving the involvement of inflammatory changes. The results of this study provide new evidence for specific bioenergetic profiles of immune cells and elevated inflammation-related molecules in ASD. For the first time, data on a unique metabolic profile in ASD R(+) and its comparison with a random group of children of similar age and sex are provided. Our data show that mitochondrial dysfunction is more significant in ASD R(+), while in ASD R(-) inflammation is more pronounced. Probably, in the group without regression, immune mechanisms (immune dysregulation, leading to inflammation) begin initially, and at a later stage mitochondrial activity is also affected under exogenous factors. On the other hand, in the regressed group, the initial damage is in the mitochondria, and perhaps at a later stage immune dysfunction is involved. Full article

Background: This systematic review and meta-analysis aimed to analyze whether isoinertial flywheel training (FWT) is superior to traditional resistance training (TRT) in enhancing maximal strength and muscle power in healthy individuals. Methods: Electronic searches were conducted in the Web of Science, PubMed, Cochrane Library, SPORTDiscus, and Scopus databases up to 21 April 2024. Outcomes were analyzed as continuous variables using either a random or fixed effects model to calculate the standardized mean difference (SMD) and 95% confidence intervals (CI). Results: A total of sixteen articles, involving 341 subjects, met the inclusion criteria and were included in the statistical analyses. The pooled results indicate no statistically significant differences between FWT and TRT in developing maximal strength in healthy individuals (SMD = 0.24, 95% CI [−0.26, 0.74], p = 0.35). Additionally, the pooled outcomes showed a small-sized effect in muscle power with FWT (SMD = 0.47, 95% CI [0.10, 0.84]), which was significantly higher than that with TRT (p = 0.01) in healthy individuals. Subgroup analysis revealed that when the total number of FWT sessions is between 12 and 18 (1–3 times per week), it significantly improves muscle power (SMD = 0.61, 95% CI [0.12, 1.09]). Significant effects favoring FWT for muscle power were observed in both well-trained (SMD = 0.58, 95% CI [0.04, 1.13]) and untrained individuals (SMD = 1.40, 95% CI [0.23, 2.57]). In terms of exercise, performing flywheel training with squat and lunge exercises significantly enhances muscle power (SMD = 0.43; 95% CI: 0.02–0.84, and p = 0.04). Interestingly, FWT was superior to weight stack resistance training (SMD = 0.61, 95% CI [0.21, 1.00]) in enhancing muscle power, while no significant differences were found compared to barbell free weights training (SMD = 0.36, 95% CI [−0.22, 0.94]). Conclusions: This meta-analysis confirms the superiority of FWT compared to TRT in promoting muscle power in both healthy untrained and well-trained individuals. Squats and lunges for FWT are more suitable for improving lower limb explosive power. It is recommended that coaches and trainers implement FWT for six weeks, 2–3 times per week, with at least a 48 h interval between each session. Although FWT is not superior to free weights training, it is advisable to include FWT in sport periodization to diversify the training stimuli for healthy individuals. Full article

The study aimed to investigate the extended effects and interrelations of corneal biomechanics, corneal optical density (COD), corneal thickness (CT), and intraocular pressure (IOP) following cataract surgery. Sixteen eyes were analyzed prospectively. The Corneal Visualization Scheimpflug Technology (Corvis ST) device assessed corneal biomechanics, while the Pentacam AxL^® (Pentacam) measured COD and CT. Postoperative data were collected around six months after surgery, with a subgroup analysis of data at nine months. The Pearson correlation was used to examine the relationship between surgical-induced changes in corneal biomechanics and COD. At six months, significant postoperative differences were observed in various biomechanical indices, including uncorrected IOP (IOPuct) and biomechanics-corrected IOP (bIOP). However, many indices lost statistical significance by the nine-month mark, suggesting the reversibility of postoperative corneal changes. Postoperative COD increased at the anterior layer of the 2−6 mm annulus and incision site. The changes in COD correlated with certain biomechanical indices, including maximal (Max) deformative amplitude (DA) and stiffness parameter (SP). In conclusion, despite significant immediate postoperative changes, corneal biomechanics, COD, and IOP experienced a gradual recovery process following cataract surgery. Clinicians should maintain vigilance for any unusual changes during the short-term observation period to detect abnormalities early. Full article

The inclusion of exogenous phytase in P- and Ca-deficient diets of broilers to address the growing concern about excessive P excretion into the environment over the years has been remarkably documented. However, responses among these studies have been inconsistent because of the several factors affecting P utilization. For this reason, a systematic review with a meta-analysis of results from forty-one studies published from 2000 to February 2024 was evaluated to achieve the following: (1) quantitatively summarize the size of phytase effect on growth performance, bone strength and mineralization in broilers fed diets deficient in P and Ca and (2) estimate and explore the heterogeneity in the effect size of outcomes using subgroup and meta-regression analyses. The quality of the included studies was assessed using the Cochrane Collaboration’s SYRCLE risk of bias checklists for animal studies. Applying the random effects models, Hedges’ g effect size of supplemented phytase was calculated using the R software (version 4.3.3, Angel Food Cake) to determine the standardized mean difference (SMD) at a 95% confidence interval. Subgroup analysis and meta-regression were used to further explore the effect size heterogeneity (P_SMD ≤ 0.05, I² > 50%, n ≥ 10). The meta-analysis showed that supplemental phytase increases ADFI and BWG and improves FCR at each time point of growth (p < 0.0001). Additionally, phytase supplementation consistently increased tibia ash, P and Ca, and bone strength (p < 0.0001) of broilers fed P- and Ca-deficient diets. The results of the subgroup and meta-regression analyses showed that the age and strain of broiler, dietary P source, and the duration of phytase exposure significantly influence the effect size of phytase on growth and bone parameters. In conclusion, phytase can attenuate the effect of reducing dietary-available phosphorus and calcium and improve ADFI, BWG, and FCR, especially when added to starter diets. It further enhances bone ash, bone mineralization, and the bone-breaking strength of broilers, even though the effects of bone ash and strength can be maximized in the starter phase of growth. However, the effect sizes of phytase were related to the age and strain of the broiler, dietary P source, and the duration of phytase exposure rather than the dosage. Full article

Background/Objectives: Periprocedural blood pressure changes in stroke patients with a large vessel occlusion are a known modifiable risk factor of unfavorable treatment outcomes. We aimed to evaluate the association between pre-revascularization hypotension and the final infarct volume. Methods: In our retrospective analysis, we included 214 consecutive stroke patients with an anterior circulation large vessel occlusion that underwent mechanical thrombectomy under general anesthesia. Noninvasively obtained blood pressure values prior to symptomatic vessel recanalization were analyzed as a predictor of post-treatment infarct size. Linear logistic regression models adjusted for predefined factors were used to investigate the association between blood pressure parameters and the final infarct volume. Results: In our cohort, higher baseline systolic blood pressure (aβ = 8.32, 95% CI 0.93–15.7, p = 0.027), its maximal absolute drop (aβ = 6.98, 95% CI 0.42–13.55, p = 0.037), and >40% mean arterial pressure decrease (aβ = 41.77, CI 95% 1.93–81.61, p = 0.040) were independently associated with higher infarct volumes. Similarly, continuous hypotension measured as intraprocedural cumulative time spent below either 100 mmHg (aβ = 3.50 per 5 min, 95% CI 1.49–5.50, p = 0.001) or 90 mmHg mean arterial pressure (aβ = 2.91 per 5 min, 95% CI 0.74–5.10, p = 0.010) was independently associated with a larger ischemia size. In the subgroup analysis of 151 patients with an M1 middle cerebral artery occlusion, two additional factors were independently associated with a larger ischemia size: systolic blood pressure maximal relative drop and >40% drop from pretreatment value (aβ = 1.36 per 1% lower than baseline, 95% CI 0.04–2.67, p = 0.043, and aβ = 43.01, 95% CI 2.89–83.1, p = 0.036, respectively). No associations between hemodynamic parameters and post-treatment infarct size were observed in the cohort of intracranial internal carotid artery occlusion. Conclusions: In patients with ischemic stroke due to a proximal middle cerebral artery occlusion, higher pre-thrombectomy treatment systolic blood pressure is associated with a larger final infarct size. In patients treated under general anesthesia, hypotension prior to the M1 portion of middle cerebral artery recanalization is independently correlated with the post-treatment infarct volume. In this group, every 5 min spent below the mean arterial pressure threshold of 100 mmHg is associated with a 4 mL increase in ischemia volume on a post-treatment NCCT. No associations between blood pressure and final infarct volume were present in the subgroup of patients with an intracranial internal carotid artery occlusion. Full article

Basal Cell Carcinoma (BCC) is the most common type of cancer among the white population. Individuals with fair skin have an average lifetime risk of around 30% for developing BCC, and there is a noticeable upward trend in its incidence rate. The principal treatment objectives for BCC involve achieving the total excision of the tumor while maximizing the preservation of function and cosmesis. Surgery is considered the treatment of choice for BCC for two main reasons: it allows for the highest cure rates and facilitates histological control of resection margins. However, in the subgroup of patients with low-risk recurrence or medical contraindications for surgery, new non-surgical treatment alternatives can provide an excellent oncological and cosmetic outcome. An evident and justified instance of these local therapies occurred during the COVID-19 pandemic, a period when surgical interventions carried out in hospital settings were not a viable option. Full article

Background: The high prevalence of injuries in female athletes necessitates a course of action that not only enhances research in this field but also incorporates improved prevention programs and regular health monitoring of highly stressed structures such as tendons and muscles. Since myometry is already used by coaches and physiotherapists, it is important to investigate whether tissue stiffness varies in different types of sports, and whether such measures are affected by an acute training session. Methods: Myometric measurements of the Achilles tendon (AT) and soleus muscle (SM) were performed in the longitudinal plane and relaxed tendon position. In total, 38 healthy professional female athletes were examined, applying a quasi-experimental study design, with subgroup analysis performed for different sports. To investigate the stiffness of the AT and SM, 24 female handball and volleyball athletes performed a standardized maximal incremental performance test on a treadmill. In this subgroup, myometric measurements were taken before and after the exercise test. Results: The measurements showed no significant difference between the mean pre- (AT: 661.46 N/m; SM 441.48 N/m) and post-exercise stiffness (AT: 644.71 N/m; SM: 439.07 N/m). Subgroup analysis for different types of sports showed significantly lower AT and SM stiffness in swimming athletes compared to handball (p = 0.002), volleyball (p = 0.000) and hammer throw athletes (p = 0.008). Conclusions: Myometry can be performed on the same day as an acute training session in healthy female professional volleyball and handball athletes. Female swimmers have significantly lower AT and SM stiffness compared to female handball, volleyball and hammer throw athletes. These results show that the stiffness differences in the AT and SM can be assessed by myometry. Full article

Introduction: The certification of oncological units as colorectal cancer centers (CrCCs) has been proposed to standardize oncological treatment and improve the outcomes for patients with colorectal cancer (CRC). The proportion of patients with CRC in Germany that are treated by a certified center is around 53%. Lately, the effect of certification on the treatment outcomes has been critically discussed. Aim: Our aim was to investigate the treatment outcomes in patients with rectal carcinoma at certified CrCCs, in German hospitals of different medical care levels. Methods: We performed a retrospective analysis of a prospective, multicentric database (AN Institute) of adult patients who underwent surgery for rectal carcinoma between 2002 and 2016. We included 563 patients from 13 hospitals of different medical care levels (basic, priority, and maximal care) over periods of 5 years before and after certification. Results: The certified CrCCs showed a significant increase in the use of laparoscopic approach for rectal cancer surgery (5% vs. 55%, p < 0.001). However, we observed a significantly prolonged mean duration of surgery in certified CrCCs (161 Min. vs. 192 Min., p < 0.001). The overall morbidity did not improve (32% vs. 38%, p = 0.174), but the appearance of postoperative stool fistulas decreased significantly in certified CrCCs (2% vs. 0%, p = 0.036). Concerning the overall in-hospital mortality, we registered a positive trend in certified centers during the five-year period after the certification (5% vs. 3%, p = 0.190). The length of preoperative hospitalization (preop. LOS) was shortened significantly (4.71 vs. 4.13 days, p < 0.001), while the overall length of in-hospital stays was also shorter in certified CrCCs (20.32 vs. 19.54 days, p = 0.065). We registered a clear advantage in detailed, high-quality histopathological examinations regarding the N, L, V, and M.E.R.C.U.R.Y. statuses. In the performed subgroup analysis, a significantly longer overall survival after certification was registered for maximal medical care units (p = 0.029) and in patients with UICC stage IV disease (p = 0.041). In patients with UICC stage III disease, we registered a slightly non-significant improvement in the disease-free survival (UICC III: p = 0.050). Conclusions: The results of the present study indicate an improvement in terms of the treatment quality and outcomes in certified CrCCs, which is enforced by certification-specific aspects such as a more differentiated surgical approach, a lower rate of certain postoperative complications, and a multidisciplinary approach. Further prospective clinical trials are necessary to investigate the influence of certification in the treatment of CRC patients. Full article

Background: We aimed to elucidate the clinical significance of tumor stiffness across breast cancer subtypes and establish its correlation with the tumor-infiltrating lymphocyte (TIL) levels using shear-wave elastography (SWE). Methods: SWE was used to measure tumor stiffness in breast cancer patients from January 2016 to August 2020. The association of tumor stiffness and clinicopathologic parameters, including the TIL levels, was analyzed in three breast cancer subtypes. Results: A total of 803 patients were evaluated. Maximal elasticity (E_max) showed a consistent positive association with an invasive size and the pT stage in all cases, while it negatively correlated with the TIL level. A subgroup-specific analysis revealed that the already known parameters for high stiffness (lymphovascular invasion, lymph node metastasis, Ki67 levels) were significant only in hormone receptor-positive and HER2-negative breast cancer (HR + HER2-BC). In the multivariate logistic regression, an invasive size and low TIL levels were significantly associated with E_max in HR + HER2-BC and HER2 + BC. In triple-negative breast cancer, only TIL levels were significantly associated with low E_max. Linear regression confirmed a consistent negative correlation between TIL and E_max in all subtypes. Conclusions: Breast cancer stiffness presents varying clinical implications dependent on the tumor subtype. Elevated stiffness indicates a more aggressive tumor biology in HR + HER2-BC, but is less significant in other subtypes. High TIL levels consistently correlate with lower tumor stiffness across all subtypes. Full article

Background: Psoriasis is a chronic, inflammatory, immune-mediated disease with a specific cutaneous presentation. Increased platelet aggregation has been observed in patients with extensive psoriatic lesions. The aim of this study was to evaluate the clinical factors affecting platelet reactivity in patients with an exacerbation of psoriasis. Methods: This was a prospective, single-center, observational study, enrolling patients hospitalized for an aggravation of psoriasis. Enrolled patients underwent single platelet function testing with light transmission aggregometry on the first morning of hospitalization. Results: 120 patients were enrolled in the study. Of the compared subgroups, women had higher maximal platelet aggregation (MPA) than men (77% vs. 72%; p = 0.03), and those with BMIs < 25 kg/m² showed higher platelet reactivity compared to subjects with BMIs ≥ 25 kg/m² (75% vs. 73%; p = 0.02). There was a positive correlation between MPA and platelet count (r = 0.27; p < 0.01), as well as C-reactive protein concentration (r = 0.20; p = 0.03), while a negative correlation was observed with total cholesterol (r = −0.24; p = 0.01) and triglycerides (r = −0.30; p < 0.01). A two-step analysis based on multidimensional models with random effects revealed that every increase in the platelet count by 10³/μL led to an increase in MPA by 0.07% (R² = 0.07; p < 0.01), and an increase in triglycerides’ concentration by 1 mg/dL was related to a reduction in MPA by 0.05% (R² = 0.07; p < 0.01). Conclusions: The increased platelet reactivity observed in patients with psoriasis appears to be multifactorial and related to several clinical and laboratory features. Further research is warranted to put these findings into a clinical perspective. Full article