Moderate intensity continuous and high intensity interval training as strategy cardioprotective on cardiotoxicity induced by cancer. Randomized clinical trial

Introduction

The adverse physiological consequences of cancer therapy have been recognized for some years. However, Cardio-Oncology aims to detect and manage cardiac dysfunction induced by cancer treatment (Cardiotoxicity) and one of the strategies used is physical exercise, which has shown benefits in cardiovascular fitness in patients with cancer; therefore, this clinical trial has like objective determine the effects cardiovascular of Moderate Intensity Continuous Training (MICT) and High Intensity Interval Training (HIIT) on cardiotoxicity induced for antitumoral treatment.

Methodology

Randomized controlled trial of 3 years and 4 months with a sample of 753 stage II cancer patients (Prostate cancer, breast, colorectal, thyroid, cervico-uterine, lung, stomach, liver) distributed in 3 groups (MICT, HIIT and control group). Echocardiogram, cardiac biomarkers, stress test, clinical and hemodynamic parameters, risk factors, hematological samples for blood glucose and lipid profile were identified. In addition, 6-minute walk, anthropometry, quality of life, fatigue, sarcopenia, depression, anxiety. The tests were performed before and after 36 session of 70-minute training, 3 times per week. A database was created with results of tests and questionnaires pre and post training. Then, descriptive statistics were carried out to estimate, the normality of the data was assessed by the Kolmogorov-Smirnov test and the indication of specificity was evident for all analyzes. Also, through the Tukey test, the ANOVA analysis of variance (two-way analysis of variance) was used, and subsequently, post hoc tests to assess the characteristics of the different age groups, gender and anthropometry. In all cases, a significance level was 5% (p= <0.05).

Results

After exercise program, there was an increase in ejection fraction (EG1: 37±3 vs 41±3; EG2: 39±4 vs 47±5; CG: 40±3 vs 40±1; p<0.05). In fact, higher values were observed in Vo2p for experimental group 2-HIIT (7.7±6.4 vs 9.8±3.9) compared to experimental group 1-MICT (8.0±4 vs 8.5±3) and control group (9.0±5.6 vs 9.2±3.9). Likewise, in the values of the systolic blood pressure (139±11 vs 129±2), diastolic blood pressure (86±6 vs 80±1), maximum heart rate (168±11 vs 179±8) and quality of life (109±12 vs 76.5±10). It was possible to show significant changes in all variables of the HIIT and MICT groups (p= <0.05) compared to the control group.

Conclusions

HIIT and MICT in cancer patients improved the ventricular ejection fraction, hemodynamic parameters, exercise tolerance, depression, anxiety, strength, vo2p, MHR, fatigue associated cancer and others variables like sarcopenia, lipidic profile and quality of life. In fact, it was possible to demonstrate greater benefits of HIIT compared to the MICT and control group. It's noteworthy that the control group without physical training, decreased the vo2 and muscular force and increased the sarcopenia, depression and anxiety.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Centro de Estudios e Investigaciόn FISICOL

Effect of exercise-based cardiac rehabilitation on the ischemic threshold in patients with high-risk ischemic heart disease

Introduction

Coronary artery disease is a complex condition and is not always resolved after an interventional or surgical procedure, due to the remaining obstructions in the coronary tree or the severity of the atherosclerosis, leaving anginal symptoms, ischemic threshold (IU) in the exercise, decreased cardiorespiratory fitness, and poor quality of life (QoL). Exercise-based cardiac rehabilitation programs (Ex-CRP) usually develop ischemic preconditioning mechanisms thanks to their direct anti-inflammatory, antioxidant, antithrombotic and coronary neovascularization effects, thus improving coronary reserve flow. We hypothesize that an Ex-CRP is capable of favorably impacting the UI in these patients. Therefore, the objective of this study is to evaluate the effects of an Ex-CRP on the UI in patients with high-risk ischemic heart disease.

Methods

Quasi-experimental study with 121 patients with ischemic threshold due to high-risk ischemic heart disease (with perfusion defects in nuclear medicine, complex coronary anatomy or partially revascularized) and presence of ischemic threshold in the exercise test. An Ex-CRP of 4–6 weeks duration was performed, consisting of supervised and monitored training concurrent with 30-minute aerobic exercise sessions at 70% of heart rate reserve, 3 times per week, supplemented with resistance exercise. and an educational understanding program for the control of risk factors and nutritional and psycho-emotional care. At the end of the program, a stress test was performed to compare the post-intervention effects and ischemic threshold was defined as the presence of angina or electrocardiographic changes of ischemia with negative ST-segment depression in 2 consecutive beats more than 80 ms from the J point. and in more than two contiguous leads.

Results

The 121 patients with ischemic threshold were 61±10 years old and 75% were male. On the other hand, 29.7% had a diagnosis of heart failure and an average LVEF of 53.1±12.9%. After Ex-CRP, an improvement was found in calculated VO2p (24.7±7.8 vs 34.23±7.5; p=0.000), METs at maximum effort from 7.06±2.15 to 9.78±1.14 (p<0.0001) and submaximal load in watts from 44±21.32 to 61±24.49; p<0.0001. 40.5% of the patients who were admitted with UI resolved it (absence of post-intervention ischemic diagnosis) after Ex-CRP and the remaining percentage with UI (59.5%) displaced it by 2.62 METs (p<0.0001). With this, the cardiovascular risk calculated by the Duke Score also decreased from −7 to −2 (p<0.0001), and the myocardial efficiency index improved from 8 to 6 (p<0.0001), strength (79±15 to 92±8%; p<0.0001) and QoL (65±17 vs 82±12; p<0.0001).

Conclusions

Ex-CRP had a significant effect on the resolution or displacement of the UI in patients with high-risk ischemic heart disease. In addition, it improved muscle strength, quality of life, myocardial efficiency, and reduced the cardiovascular risk index calculated by the Duke score.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Centro de Estudios e Investigaciόn FISICOL. Cúcuta, ColombiaCardioFit. CDMX, México

The role of oligodendrocytes in chronic pain: cellular and molecular mechanisms

Oligodendrocytes are glial cells responsible for the myelination of axons within the central nervous system. Many studies have demonstrated that glial cells, mainly microglia and astrocytes, are actively involved in many pathological pain states. Although oligodendrocytes have been widely studied in relation to neurodegenerative diseases, their role in pain genesis in the spinal cord is minimally described and not well understood. Few studies have proposed novel molecules or mechanisms of interaction with consistent evidence of oligodendrocyte participation in the central pain process; however, recent findings support a potential role of oligodendrocytes in chronic pain. Therefore, this review aimed to gather and analyze scientific findings related to the contribution of oligodendrocytes to this symptom. Based on these previous studies, we focused on describing the specific mechanisms involved in the participation of oligodendrocytes in pain genesis.

Endogenous systems involved in exercise-induced analgesia

Exercise-induced analgesia is a phenomenon discussed worldwide. This effect began to be investigated in the early 1970s in healthy individuals and rodents during and after an acute or chronic session of running or swimming. Thereafter, studies found this effect was also induced by resistance exercises. Over the years, many studies have demonstrated the importance of exercise-induced analgesia in relieving pain caused by different conditions, such as fibromyalgia, low back pain, neuropathy, and osteoarthritis. This review aims to provide the reader with an in-depth description of the main endogenous systems, substances, neurotransmitters, receptors and enzymes that are thought to be involved in the analgesic effect induced by exercise. Many hypotheses have been proposed to elucidate the mechanisms responsible for exercise-induced analgesia. One of the most accepted hypotheses has been the activation of several endogenous systems described as analgesics. Studies have demonstrated that during and after exercise different endogenous systems are activated, which release substances or neurotransmitters, such as opioids, nitric oxide, serotonin, catecholamines and endocannabinoids, that may modulate the pain perception.

St36 electroacupuncture activates nNOS, iNOS and ATP-sensitive potassium channels to promote orofacial antinociception in rats

Orofacial pain is pain perceived in the face and/or oral cavity, generally caused by diseases or disorders of regional structures, by dysfunction of the nervous system, or through referral from distant sources. Treatment of orofacial pain is mainly pharmacological, but it has increased the number of reports demonstrating great clinical results with the use of non-pharmacological therapies, among them electroacupuncture. However, the mechanisms involved in the electroacupuncture are not well elucidated. Thus, the present study investigate the involvement of the nitric oxide synthase (NOS) and ATP sensitive K⁺ channels (KATP) in the antinociception induced by electroacupuncture (EA) at acupoint St36. Thermal nociception was applied in the vibrissae region of rats, and latency time for face withdrawal was measured. Electrical stimulation of acupoint St36 for 20 minutes reversed the thermal withdrawal latency and this effect was maintained for 150 min. Intraperitoneal administration of specific inhibitors of neuronal nitric oxide synthase (nNOS), inducible nitric oxide synthase (iNOS) and a KATP channels blocker reversed the antinociception induced by EA. Furthermore, nitrite concentration in cerebrospinal fluid (CSF) and plasma, increased 4 and 3-fold higher, respectively, after EA. This study suggests that NO participates of antinociception induced by EA by nNOS, iNOS and ATP-sensitive K⁺ channels activation.

Does tumescent infiltration have a deleterious effect on undermined skin flaps?

In summary, we think that the intradermal injection of the tumescent solution with epinephrine, which produced a peau d'orange appearance of the overlying skin, resulted in superficial flap loss secondary to the vasoconstrictive property of epinephrine combined with the hydrostatic pressure of the injection in this patient within a superficial plane and flap elevation. This delayed the clearance of epinephrine from the flaps. In this case, removal of the sutures did not result in any improvement in the flap, and this maneuver was performed too late. If a peau d'orange appearance is observed after injection, we recommend waiting until the fluid has time to recirculate (15 to 30 minutes, at a minimum) and avoid immediate incising or undermining of the flap.