Impact of Low Hemoglobin on Body Composition, Strength, and Redox Status of Older Hemodialysis Patients Following Resistance Training

Correlation between hemoglobin levels and depression in late-stage cancer patients with irritability as mediating variable

PURPOSE

In late-stage cancer, the cancer itself or the side effects of cancer treatment are known to affect the hemoglobin (Hgb) levels or emotions of patients. We to investigate the relationship between Hgb levels and depression in late-stage cancer patients and verified whether irritability has a mediating effect on this relationship.

METHOD

The research tools included a patient basic information form, the Irritability Scale-Initial Version (TISi), and the Hamilton Depression Rating Scale (HAMD). We first compared the Hgb levels, HAMD scores, and TISi scores of the cancer patients with different attributes, performed multiple hierarchical regression analysis, and then analyzed the mediating effects of TISi scores using the Sobel test.

RESULTS

In the 117 late-stage cancer patients, Hgb levels of patients with a BMI<18.5 kg/m2 were lower than those of the patients with a BMI 24.0 kg/m2. Hgb levels had a negative influence on both TISi scores (B = -2.74, p = .001) and HAMD scores (B = -0.75, p = .010). TISi scores mediated the relationship between Hgb levels and HAMD scores (Z = 2.06, p = .040).

CONCLUSIONS

Irritability is a mediating variable of the influence of Hgb levels on depression, meaning that lower Hgb levels in late-stage cancer patients may be detrimental to emotional stability, induce irritability, and thereby cause depression. Thus, in the psychological care of late-stage cancer patients, medical teams should be more vigilant in monitoring Hgb levels and anemia treatment.

Reliability and Validity of a Portable Traction Dynamometer in Knee-Strength Extension Tests: An Isometric Strength Assessment in Recreationally Active Men

BACKGROUND

the study determined the validity and reliability of measurements obtained using the portable traction dynamometer (PTD) (E-Lastic, E-Sports Solutions, Brazil) and the reproducibility between evaluators (precision) in the evaluation of the isometric muscle strength of the knee extensors of healthy male adults, compared to measurements obtained with the "gold standard" computerized dynamometer (CD) (Biodex System 3, Nova York, NY, USA).

METHODS

we evaluated sixteen recreationally active men (29.50 ± 7.26 years). The test-retest reliability of both equipment to determine quadriceps strength, agreement analysis, and the minimal important difference were verified.

RESULTS

excellent test-retest interrater reliability was observed for absolute and relative measurements, with a low absolute error for both sets of equipment and excellent validity of the PTD against the CD, as verified by linear regression and Pearson's correlation coefficient.

CONCLUSIONS

PTD is a valid and reliable instrument for assessing the isometric strength of knee extensors, with results similar to the isometric CD "gold standard".

Twelve Weeks of High-Intensity Interval Training Alters Adipose Tissue Gene Expression but Not Oxylipin Levels in People with Non-Alcoholic Fatty Liver Disease

Lifestyle modifications, including increased physical activity and exercise, are recommended for non-alcoholic fatty liver disease (NAFLD). Inflamed adipose tissue (AT) contributes to the progression and development of NAFLD and oxylipins such as hydroxyeicosatetraenoic acids (HETE), hydroxydocosahexanenoic acids (HDHA), prostaglandins (PEG₂), and isoprostanoids (IsoP), which all may play a role in AT homeostasis and inflammation. To investigate the role of exercise without weight loss on AT and plasma oxylipin concentrations in NAFLD subjects, we conducted a 12-week randomized controlled exercise intervention. Plasma samples from 39 subjects and abdominal subcutaneous AT biopsy samples from 19 subjects were collected both at the beginning and the end of the exercise intervention. In the AT of women, a significant reduction of gene expression of hemoglobin subunits (HBB, HBA1, HBA2) was observed within the intervention group during the 12-week intervention. Their expression levels were negatively associated with VO₂max and maxW. In addition, pathways involved in adipocyte morphology alterations significantly increased, whereas pathways in fat metabolism, branched-chain amino acids degradation, and oxidative phosphorylation were suppressed in the intervention group (p < 0.05). Compared to the control group, in the intervention group, the ribosome pathway was activated, but lysosome, oxidative phosphorylation, and pathways of AT modification were suppressed (p < 0.05). Most of the oxylipins (HETE, HDHA, PEG₂, and IsoP) in plasma did not change during the intervention compared to the control group. 15-F_2t-IsoP significantly increased in the intervention group compared to the control group (p = 0.014). However, this oxylipin could not be detected in all samples. Exercise intervention without weight loss may influence the AT morphology and fat metabolism at the gene expression level in female NAFLD subjects.

Effect of exercise and antioxidant supplementation on cellular lipid peroxidation in elderly individuals: Systematic review and network meta-analysis

Background: The viewpoints of previous studies on the correlation between exercise and cellular lipid peroxidation are contradictory from many perspectives and lack evidence for elder individuals. A new systematic review with network meta-analysis is necessary and will have significant practical value to provide high-quality evidence in the development of exercise protocols and an evidence-based guide for antioxidant supplementation for the elderly. Aims: To identify the cellular lipid peroxidation induced by different types of exercise, with or without antioxidant supplementation, in elderly individuals. Methods: Randomized controlled trials that recruited elderly participants and reported cellular lipid peroxidation indicators and were published in peer-reviewed journals in English were searched by a Boolean logic search strategy and screened in the databases PubMed, Medline, Embase, and Web of Science. The outcome measures were the biomarkers of oxidative stress in cell lipids in urine and blood, namely F2-isoprostanes, hydrogen peroxide (LOOH, PEROX, or LIPOX), malondialdehyde (MDA), and thiobarbituric acid reactive substances (TBARS). Result: 7 trials were included. A combination program of aerobic exercise (AE), low-intensity resistance training (LIRT), and a placebo intake (Placebo) and a combination program of aerobic exercise, low-intensity resistance training, and antioxidant supplementation (S) had the most and sub-most potential to dampen cellular lipid peroxidation (AE + LIRT + Placebo: 0.31 in Rank 1 and 0.2 in Rank 2; AE + LIRT + S: 0.19 in Rank 1 and 0.20 in Rank 2); A placebo intake (Placebo) and a blank intervention without exercise (NE) had the most and sub-most potential to induce an enhancement of cellular lipid peroxidation (Placebo: 0.51 in Rank 9 and 0.16 in Rank 8; NE: 0.16 in Rank 9 and 0.28 in Rank 8). All included studies had an unclear risk of selecting reporting. There were no high confidence ratings in all the direct and indirect comparisons, 4 comparisons in the direct evidence structure and 7 comparisons in the indirect evidence structure had moderate confidence. Conclusion: A combined protocol consisting of aerobic exercise and low-intensity resistance training is recommended to dampen cellular lipid peroxidation. Extra antioxidant supplementation might be unnecessary if an elderly individual has enough aerobic and resistance exercise. Systematic Review Registration: CRD42022367430.

Association Between Protocols of the Sit-to-Stand Test and Lower Limb Muscle Force Output in Patients on Hemodialysis and Subjects Without Chronic Kidney Disease

OBJECTIVE

To evaluate the association of three protocols of the sit-to-stand (STS) test with muscle force output of knee extension (KE) and knee flexion (KF) in patients on hemodialysis and subjects without chronic kidney disease.

METHODS

This cross-sectional study included a hemodialysis group [n = 60, 59.5 (16.8) years, 55% female] and a control group [n = 60, 43.0 (11.8) years, 50% female]. The assessments were performed in 2 days, and the participants were submitted to three protocols of STS test (5-repetition STS, 10-repetition STS and 30-s STS) or muscle force output of the KE and KF evaluation by handheld dynamometer based on randomization.

RESULTS

The hemodialysis group presented reduced muscle force output of the KE and KF, a longer time to perform the 5 STS and 10 STS tests, and a lower number of repetitions in the 30-s STS test. The three STS tests were associated with muscle force output of the KE in the hemodialysis group, in which the 10-repetition STS test showed the best association (R² = 0.47; adjusted R² = 0.42). However, the only association between the STS test and muscle force output of the KE in the control group was found in the 10-repetition STS test (R² = 0.20; adjusted R² = 0.13).

CONCLUSIONS

The three protocols of STS tests were associated with muscle force output of the KE in patients on hemodialysis. However, the 10-repetition STS test was the best protocol to estimate the quadriceps muscle torque in these patients.

Synergistic deterioration of prognosis associated with decreased grip strength and hyporesponse to erythropoiesis-stimulating agents in patients undergoing hemodialysis

Introduction

We examined the combined effect of erythropoietin (EPO) hyporesponsiveness and low handgrip strength (HGS) on the prognosis of patients undergoing hemodialysis (HD).

Methods

We recruited patients with chronic kidney disease (CKD) Stage 5, who were undergoing HD at our dialysis clinic between January 2015 and March 2015 (n = 182). Patients of ≥20 years of age and who had been undergoing HD for ≧3 months at enrollment were eligible for inclusion. Seven patients treated with epoetin-β pegol were excluded. First, the erythropoietin resistance index (ERI) and HGS were measured. The patients were stratified by the ERI of 9.44 (U/kg/week/g/dL), and by the HGS of 28 kg for men and 18 kg for women. We then observed death and cardiovascular disease (CVD), composite endpoint (deaths or CVD) for a median of 2 years.

Results

A total of 175 patients (male, n = 122; female, n = 53; age, 34–92 years) were included in the analysis. During the observation period of 24 months, 57 events (14 deaths and 43 CVD) were observed. High ERI and low HGS were associated with a high incidence of endpoints compared to low ERI and high HGS. Among the four groups classified by ERI and HGS values, the highest risk group was the high ERI/low HGS group (HR: 4.20 95% CI 2.12–8.33).

Conclusions

EPO hyporesponsiveness combined with low HGS were found to be significant predictors of a poor outcome, and the synergistic effects of the two factors had stronger predictive ability than either single factor.

Does the Combined Effect of Resistance Training with EPO and Iron Sulfate Improve Iron Metabolism in Older Individuals with End-Stage Renal Disease?

We sought to investigate the effects of resistance training (RT) combined with erythropoietin (EPO) and iron sulfate on the hemoglobin, hepcidin, ferritin, iron status, and inflammatory profile in older individuals with end-stage renal disease (ESRD). ESRD patients (n: 157; age: 66.8 ± 3.6; body mass: 73 ± 15; body mass index: 27 ± 3), were assigned to control (CTL; n: 76) and exercise groups (RT; n: 81). The CTL group was divided according to the iron treatment received: without iron treatment (CTL-none; n = 19), treated only with iron sulfate or EPO (CTL-EPO or IRON; n = 19), and treated with both iron sulfate and EPO (CTL-EPO + IRON; n = 76). The RT group followed the same pattern: (RT-none; n = 20), (RT-EPO or IRON; n = 18), and (RT-EPO + IRON; n = 86). RT consisted of 24 weeks/3 days per week at moderate intensity of full-body resistance exercises prior to the hemodialysis section. The RT group, regardless of the iron treatment, improved iron metabolism in older individuals with ESRD. These results provide some clues on the effects of RT and its combination with EPO and iron sulfate in this population, highlighting RT as an important coadjutant in ESRD-iron deficiency.