The effectiveness of eHealth interventions on moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants: a systematic review and meta-analysis

Background

Cardiac rehabilitation is a class IA recommendation for patients with cardiovascular diseases. Physical activity is the core component and core competency of cardiac rehabilitation programs. Cardiac rehabilitation guidelines recommend patients achieve at least thirty minutes of moderate-to-vigorous intensity physical activity five or more days per week. However many patients with cardiovascular diseases are failing to meet recommended daily physical activity levels. eHealth interventions may increase moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants.

Objectives

The objective of this study was to review the evidence of the effectiveness of eHealth interventions to increase moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants. The secondary objective was to examine the effectiveness of eHealth interventions on improving exercise capacity, cardiovascular risk profile and health-related quality of life.

Methods

A comprehensive search strategy was developed for four electronic databases (PubMed, Web of Science, Embase and The Cochrane Library); through December 16, 2021. All studies reporting on eHealth interventions designed to increase moderate-to-vigorous physical activity among cardiac rehabilitation participants were included. Multiple not-blind reviewers determined study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Collaboration Tool for randomized controlled trials and using the Effective Practice and Organisation of Care Cochrane Review Group for non-randomized controlled trials. Data quality using the Grading of Recommendations Assessment, Development and Evaluation professional guideline development tool. Data were pooled using a random-effects model. All statistical analyses were performed using Stata 17.

Results

Twenty-one studies were included in the review which fifteen were in the meta-analysis. The meta-analysis demonstrated eHealth interventions improved moderate-to-vigorous physical activity (standard mean difference = 0.17, 95% confidence interval: 0.07, 0.27, P<0.001). No changes were observed in exercise capacity (P=0.09), cardiovascular risk profile (body mass index, P=0.19; waist circumference, P=0.7; systolic blood pressure, P=0.36; total cholesterol, P=0.72; plasma glucose, P=0.41) and health-related quality of life (P=0.12).

Conclusions

eHealth interventions are effective at increasing minutes/week of moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants. Future high-quality empirical studies are needed to evaluate the effectiveness of eHealth interventions delivered, with these sub-types (wearable devices, online web portal, smart phone application, messaging services and telephone calls) delivered alone or in combination delivered more conducive to moderate-to-high intensity physical activity.

Funding Acknowledgement

Type of funding sources: None.

Functional maturation of immature β cells: A roadblock for stem cell therapy for type 1 diabetes

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease caused by the specific destruction of pancreatic islet β cells and is characterized as the absolute insufficiency of insulin secretion. Current insulin replacement therapy supplies insulin in a non-physiological way and is associated with devastating complications. Experimental islet transplantation therapy has been proven to restore glucose homeostasis in people with severe T1DM. However, it is restricted by many factors such as severe shortage of donor sources, progressive loss of donor cells, high cost, etc. As pluripotent stem cells have the potential to give rise to all cells including islet β cells in the body, stem cell therapy for diabetes has attracted great attention in the academic community and the general public. Transplantation of islet β-like cells differentiated from human pluripotent stem cells (hPSCs) has the potential to be an excellent alternative to islet transplantation. In stem cell therapy, obtaining β cells with complete insulin secretion in vitro is crucial. However, after much research, it has been found that the β-like cells obtained by in vitro differentiation still have many defects, including lack of adult-type glucose stimulated insulin secretion, and multi-hormonal secretion, suggesting that in vitro culture does not allows for obtaining fully mature β-like cells for transplantation. A large number of studies have found that many transcription factors play important roles in the process of transforming immature to mature human islet β cells. Furthermore, PDX1, NKX6.1, SOX9, NGN3, PAX4, etc., are important in inducing hPSC differentiation in vitro. The absent or deficient expression of any of these key factors may lead to the islet development defect in vivo and the failure of stem cells to differentiate into genuine functional β-like cells in vitro. This article reviews β cell maturation in vivo and in vitro and the vital roles of key molecules in this process, in order to explore the current problems in stem cell therapy for diabetes.

[Short-term efficacy of robotic-assisted total mesorectal excision with and without lateral lymph node dissection for mid-low advanced rectal cancer: a propensity score matching analysis]

Objective: To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi'an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups. Results: A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions: Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.

Serum 25-hydroxyvitamin D cutoffs for functional bone measures in postmenopausal osteoporosis

This study sought to determine the minimal serum 25-hydroxyvitamin D [25(OH)D] concentration required to maintain bone health in postmenopausal women with low bone mass. A serum 25(OH)D concentration of 20 ng/mL rather than 30 ng/mL was appropriate for bone health.

INTRODUCTION

There is no consensus on the minimal serum 25-hydroxyvitamin D [25(OH)D] concentration required to maintain bone health. The aim of this study was to investigate the relationship between 25(OH)D measured via liquid chromatography-mass spectrometry (LC-MS/MS), which is the current gold standard, and biochemical markers of bone turnover, PTH, and bone mineral densitometry (BMD).

METHODS

The medical records of 750 postmenopausal women newly diagnosed with osteoporosis or osteopenia at Samsung Medical Center from 2009 to 2014 were investigated. Subjects were divided into four groups according to serum 25(OH)D concentration: <10, 10-20, 20-30, and ≥30 ng/mL. Serum concentrations of bone-specific alkaline phosphatase (BS-ALP), carboxy-terminal cross-linking telopeptide of type 1 collagen (CTx), intact PTH (iPTH), and BMD were compared among the four groups using analysis of covariance. Thresholds of 25(OH)D were then assessed using spline plots and locally weighted regression smoothing (LOESS) plots.

RESULTS

25(OH)D was negatively correlated with serum BS-ALP, CTx, and iPTH. Only femur neck and total femur BMD had significant positive relationships with 25(OH)D. Cutoff values of 11.9 and 9.7 ng/mL were estimated from the spline plots of femur neck and total femur BMD, respectively. For iPTH, the LOESS plot showed a steep decrease to a serum 25(OH)D concentration of about 20 ng/mL, followed by a plateau.

CONCLUSIONS

According to this study, a serum 25(OH)D concentration of 20 ng/mL, rather than 30 ng/mL, was appropriate for bone health.

Expression of phosphorylated histone H2AX in cultured cell lines following exposure to X-rays

PURPOSE

Exposure to ionizing radiation results in phosphorylation of histone H2AX (gammaH2AX) at sites of DNA double-strand breaks. To determine the relationship between gammaH2AX formation and radiosensitivity, the rate of formation and loss of gammaH2AX were examined in several cultured cell lines following exposure to 253 kV X-rays.

MATERIALS AND METHODS

Flow and image cytometry were both performed using a mouse monoclonal antibody against gammaH2AX. Immunoblotting was used to confirm cell line-dependent differences in antibody staining. Cell lines examined included V79 and CHO-K1 hamster cells, the human tumour cell lines SiHa, WiDr, DU145, WIL-2NS, HT144, HCC1937 and U87, and the normal cell strain HFL1. Radiosensitivity was measured using a standard clonogenic assay.

RESULTS

Using flow cytometry, gammaH2AX formation was detected 1 h after doses as low as 20 cGy. Peak levels of gammaH2AX were observed within 15-30 min after irradiation and both the rate of radiation-induced gammaH2AX formation and loss were cell type dependent. Maximum levels of gammaH2AX formation were lower for HT144 cells mutant for the ataxia telangiectasia gene. Half-times of loss after irradiation ranged from 1.6 to 7.2 h and were associated with a decrease in the total number of foci per cell. The half-time of loss of gammaH2AX was correlated with clonogenic survival for 10 cell lines (r2=0.66).

CONCLUSIONS

GammaH2AX can be detected with excellent sensitivity using both flow and image analysis. The rate of gammaH2AX loss may be an important factor in the response of cells to ionizing radiation, with more rapid loss and less retention associated with more radioresistant cell lines.

Pore-to-pore hopping model for the interpretation of the pulsed gradient spin echo attenuation of water diffusion in cell suspension systems

A simplified pore-to-pore hopping model for the two-phase diffusion problem is developed for the analysis of the pulsed gradient spin echo (PGSE) attenuation of water diffusion in the condensed cell suspension systems. In this model, the two phases inside and outside the cells are treated as two different kinds of pores, and the spin-bearing molecules perform hopping diffusion between them. The size and the orientations of those two respective pores are considered, and then the diffraction pattern of the PGSE attenuation may be well simulated. Nevertheless, the intensity of the characteristic peak decreases with increasing membrane permeability, from which the exchange time may be estimated. We then analyze the experimental 1H PGSE results of the erythrocytes suspension system. The water-residence lifetime in the erythrocyte is obtained to be 10 ms, which is the same as that estimated from the two-region approximation. Furthermore, the PGSE attenuation curve of addition of p-Chloromercuribenzenesulfonate (p-CMBS) is also discussed. It predicts that the alignment of erythrocytes will become normal to the magnetic field direction after the addition of p-CMBS, and inspection using a light microscope confirms that result.

Optimized combinations of abatement strategies for urban mobile sources

The maximum incremental reactivity (MIR) scale was chosen as a practical index for quantifying ozone-forming impacts. The integer linear and nonlinear programming techniques were employed as the optimization method to maximize MIR and volatile organic compound (VOC) reductions, and minimize ozone's marginal cost with varied control costs. Mobile vehicles were divided into nine categories according to the demands of decision makers and the distinctive features of local circumstance in metro-Taipei. The emission factor (EF) and vehicle kilometers traveled (VKT) of each kind of vehicle were estimated by MOBILE5B model via native parameters and questionnaires. Compressed natural gas (CNG) and inspection and maintenance (I/M) were the alternative control programs for buses and touring buses; liquefied petroleum gas (LPG), I/M, methanol, electrical vehicle (EV) were for taxis and low duty gasoline vehicles. EV, methanol, and I/M were the possible control methods for two-stroke and four-stroke engine motorcycles; I/M programs for low-duty diesel trucks, heavy-duty diesel trucks, and low-duty gasoline trucks. The results include the emission ratios of specific vehicle to all vehicles, the best combination of abated measures based on different objectives, and the marginal cost for ozone and VOC with varied control costs.