Closure of outpatient cardiac rehabilitation during the first COVID-19 lockdown in Austria in spring 2020 resulted in deteriorating physical exercise capacity: a mixed-methods study

Background

Group-based cardiac rehabilitation (CR) has inevitably been disrupted by COVID-19-related public health measures, increasing the risk of deterioration in modifiable risk factors for patients with cardiovascular disease (CVD).

Purpose

To examine the impact of CR closure during the first COVID-19-related national lockdown in Austria in spring 2020 on patients' maintenance of physical activity, physical fitness levels, and cardiovascular risk profile; and to describe the patient experience of lack of group-based CR training due to COVID-19.

Methods

This mixed-methods study recruited patients from an outpatient CR centre in Austria during summer 2020. Eligibility criteria were regular attendance at weekly group-based exercise training at the centre until the COVID-19-related lockdown in March 2020; pre-lockdown completion of a maximal cycle ergometer test; no contraindications for maximal exercise testing; and no new complaints limiting exercise performance. Participants underwent post-lockdown quantitative assessment of physical fitness (maximal cycle ergometer testing, submaximal cycle ergometer training session at individual pre-lockdown settings) and cardiovascular risk status. These were compared with pre-lockdown data from medical records. Participants gave qualitative interviews about their experience of maintaining exercise during lockdown. Interviews were audio-recorded, transcribed, coded, and interpreted using framework analysis.

Results

Twenty-eight (57%) of 49 eligible patients were recruited, 1 withdrew, and 27 completed all study procedures. Two participants were excluded from analysis of physical fitness data, due to subsequent diagnosis of new complaints limiting exercise performance. Mean (SD) age was 69 (7.4) years. Six (22%) were female. Median (IQR) time since first CVD event was 8 (5.5, 9) years. In maximal ergometer testing, 14 (56%) had deteriorated, 10 (40%) were unchanged, and 1 (4%) had improved post-lockdown. At group level, power was significantly reduced (maximal ergometer testing, submaximal ergometer training), whereas CVD risk factors remained unchanged from pre- to post-lockdown (table 1). Qualitative analysis corroborated the negative impact of the closure of CR classes (table 2).

Conclusions

This patient cohort was heterogeneous with respect to physical activity levels and exercise capacity, yet overall motivated and experienced in exercise training, having regularly attended training sessions at the centre before the lockdown. Despite individually seeking out alternative exercise options during lockdown, group average exercise capacity deteriorated even in this motivated and exercise-conscious group. This highlights the importance of providing group-based opportunities for supervised high intensity training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ludwig Boltzmann Gesellschaft COVID-19 Support Measure: Open Innovation in Science (OIS) Research Enrichment Fund

Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP)

Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.

Scale-up on basis of structured mixing models: A new concept

A new scale-up concept based upon mixing models for bioreactors equipped with Rushton turbines using the tanks-in-series concept is presented. The physical mixing model includes four adjustable parameters, i.e., radial and axial circulation time, number of ideally mixed elements in one cascade, and the volume of the ideally mixed turbine region. The values of the model parameters were adjusted with the application of a modified Monte-Carlo optimization method, which fitted the simulated response function to the experimental curve. The number of cascade elements turned out to be constant (N = 4). The model parameter radial circulation time is in good agreement with the one obtained by the pumping capacity. In case of remaining parameters a first or second order formal equation was developed, including four operational parameters (stirring and aeration intensity, scale, viscosity). This concept can be extended to several other types of bioreactors as well, and it seems to be a suitable tool to compare the bioprocess performance of different types of bioreactors. (c) 1994 John Wiley & Sons, Inc.

Comparison of oral glucose tolerance test (OGTT) 100 g with OGTT 75 g for evaluation of acromegalic patients and the impact of gender on test reproducibility

CONTEXT

Growth hormone (GH) measurements during an oral glucose tolerance test (OGTT) are essential for the diagnosis and follow-up management of acromegaly. However, both 100 g glucose (OGTT(100) ) and 75 g glucose (OGTT(75) ) test variants are in clinical use. Whether the tests are interchangeable concerning GH nadir and test interpretation is unclear. Furthermore, information on test reproducibility and the impact of gender is scarce.

OBJECTIVE

To compare both tests in acromegalic patients and to evaluate test reproducibility with respect to gender.

DESIGN, SUBJECTS AND METHODS

OGTT(100) and OGTT(75) were performed on two consecutive days in 54 acromegalic patients (46·9 ± 1·8 years, 30 women). OGTT(75) was repeated on three different occasions in 11 healthy men and 13 healthy women at different phases of the menstrual cycle.

RESULTS

GH nadirs were comparable between tests [2·40 ± 0·52 (OGTT(100) ) and 2·46 ± 0·54 μg/l (OGTT(75) ); P = 0·356]. There were no differences at any time point in the mean values of GH, serum glucose or insulin between the two test variants. Test interpretation was highly consistent between the OGTT(100) and OGTT(75) [area under the receiver operated curve (ROC) = 0·995]. In men, GH, insulin and glucose measurements during OGTT(75) were highly reproducible. In women, however, basal and GH nadirs were significantly higher midcycle (P < 0·05).

CONCLUSIONS

In acromegalic patients, there is no difference in GH nadirs and test interpretation after the ingestion of 100 g or 75 g glucose. The OGTT(75) is highly reproducible in men, but in women, it should be performed preferably in the early follicular phase.

An inversion polymorphism of a DA/DAPI-positive chromosome pair in <i>Anas platyrhyncho</i><i>s</i> (Aves)

A specific type of heterochromatin (DA/DAPI-posi tive heterochromatin) was detected in the genome of <i>Anas platyrhynchos f</i>. <i>domestica</i> L. (domestic duck). The DA/DAPI-positive autosome pair was polymorphic with respect to its occurrenceand size and was also involved in an inversion polymorphism

N-ras mutation in a canine lymphoma: short communication

Lymphomas of dogs were investigated by molecular genetic methods. Regions of exon 1 and 2 of the N-ras gene, which harbours the mutation hot spots (codons 12, 13 and 61) were screened. A GGT [symbol: see text] GAT (glycine [symbol: see text] aspartic acid) mutation in codon 13 was present in a multicentric-type lymphoma of a 1-year-old male dog.

Successful jejunal nutrition therapy in a pregnant patient with apallic syndrome

A 41-year-old woman was admitted in the 8th pregnancy week as a consequence of a left-sided media infarction. After alloprothetic aortic valve replacement, she had discontinued deliberately the mandatory anticoagulation treatment. Following an initial clinical stabilisation, a second insult with right-sided media total infarction occurred 3 weeks after admission. In the further course, she developed an apallic syndrome and required respirator therapy. The initial enteral nutrition therapy via naso-gastric tube, was continued via percutaneous endoscopic gastrostomy (PEG). Due to recurrent vomiting from the 24th pregnancy week, the PEG was changed into a PEG with jejunal position of the tube (JET-PEG). Via this access and simultaneous body impedance analysis (BIA) control, the further nutrition therapy could be continued uneventfully. In the 27th pregnancy week, the patient gave birth to a female newborn (birth weight: 820 g) by Caesarean section in pre-eclampsia. The foetal development was in accordance with the gestational period and uncomplicated in the further course. The mother could be released into ambulatory care where the above nutrition therapy was continued. Reports on a successful nutrition therapy of pregnant comatose patients are rare. To the best of our knowledge, this is the first case where JET-PEG and monitoring by repeated BIA measurement were used for the control of the enteral nutrition.

Tumour suppressor gene p53 mutation in a case of haemangiosarcoma of a dog

Haemangiosarcomas of dogs were analysed by molecular genetic techniques. Regions of the tumour suppressor gene p53, including the well-known tumour hot spots (codons 175, 245, 248, 249, 273 and 282) were screened. A 24 bp deletion was detected in exon 5 of the gene.

Secretion of free and protein-bound leptin from subcutaneous adipose tissue of lean and obese women

Leptin circulates as a free (FL) and a protein-bound (BL) form, with the soluble leptin receptor (LR) as an important binding compound. Here we measured these components of leptin in serum and in the incubation medium of sc adipose tissue in healthy lean (n = 10) and obese (n = 13) female subjects using recently developed specific RIA systems. In addition, immunostaining for FL, BL, and LR in adipose tissue was performed. Serum FL levels were increased in the obese subjects (P < 0.0001), whereas BL and LR concentrations in serum of lean and obese subjects were similar. Both FL and BL were secreted from human preadipocytes and increased in parallel to the differentiation of the cells. In sc fat cell explants LR antibodies predominantly stained the fat cell membrane, whereas FL and BL antibodies revealed intracytoplasmatic adipocyte staining. The release of FL, BL, and LR from adipose tissue was increased in obese compared with lean subjects (P < 0.005 for FL; P < 0.02 for BL, and P < 0.01 for LR). In summary, fat cells are capable of releasing not only FL, but also BL and LR.

Canine tumour suppressor gene p53 mutation in a case of anaplastic carcinoma of the intestine

Tumours localised in the large bowel of dogs were subjected to molecular genetic studies. Highly conserved regions of the tumour suppressor gene p53, including typical tumour hot spots (codons 175, 245, 248, 249, 273 and 282), were analysed. A mutation CGG-->TGG (arginine-->tryptophan) was present in codon 249 in an anaplastic carcinoma in the caecum.

Gender-specific differences of serum leptin in obese and normal-weight adolescents: studies in type-I diabetes and Turner syndrome

The influence of exogenous insulin and estrogen substitution on serum leptin-like immunoreactivity was studied longitudinally in patients with type-I diabetes and Turner syndrome using a specific radioimmunoassay. Prepubertal, pubertal and postpubertal samples of 17 patients (9 girls, 8 boys) with type-I diabetes mellitus developing obesity were compared to those of 17 normal-weight controls matched for gender, age and diabetes duration. Six obese and six normal-weight girls with Turner syndrome were studied without hormone substitution, with ethinylestradiol alone, and with cyclic estradiol/gestagen substitution. The mean leptin levels of the girls with diabetes were two times higher than boys at all times, while insulin doses and glycemic control had no influence. In Turner syndrome estrogen substitution led to increased leptin levels only in the obese group. This study revealed that both body weight above normal and female sex steroids seem to be necessary to elevate leptin concentrations, while exogenous insulin has no effect.

Identification of novel CBFA1/RUNX2 mutations causing cleidocranial dysplasia

Core binding factor A1 (CBFA1/RUNX2) is a runt-like transcription factor essential for osteoblast differentiation. Haplotype insufficiency causes cleidocranial dysplasia (CCD), a syndrome featuring supernumerary tooth buds, delayed tooth eruption, patent fontanels, Wormian bones, short stature, dysplasia of the clavicles, growth retardation and hypoplasia of the distal phalanges. We identified novel CBFAI/RUNX2 mutations after PCR and direct sequencing of patient leukocyte DNA. In family 1 mother and son are affected by CCD. Both carry the missense mutation R190W (CGG > TGG). This nucleotide change introduced a BsmI restriction site, which was used to independently confirm the mutation. It was absent in healthy members of the family. Family 2, in which father and daughter are affected by CCD, shows a deletion of nucleotide C821. This deletion causes a frameshift mutation with premature stop after the insertion of 18 aberrant amino acids. Healthy family members did not have this mutation. The clavicular dysplasia was more pronounced with the R19OW mutation, while the bone density was markedly reduced in individuals with either mutation, suggesting a previously underemphasized increased risk for osteoporosis in CCD.

Metathesis-based monoliths: influence of polymerization conditions on the separation of biomolecules

Monolithic materials were prepared by transition metal-catalyzed ring-opening metathesis copolymerization of norborn-2-ene and 1,4,4a,5,8,8a-hexahydro-1,4,5,8-exo,endo-dimethanonaphthalene within the confines of surface-derivatized borosilicate columns in the presence of the porogenic solvents toluene and 2-propanol using Cl2(PCy3)2Ru(=CHPh) (1) as initiator. Relevant physicochemical data of the porous structure (specific surface area (sigma), pore volume (Vp), volume fraction of pores (epsilon(p)), and intermicroglobule volume (epsilon(z))) of the monolithic columns were determined by inverse size exclusion chromatography in tetrahydrofuran. Mean particle diameters were determined via electron microscopy. The influence of variations in polymerization conditions in terms of stoichiometry of the monomers and porogenic solvents on the chromatographic separation of the oligodeoxynucleotides dT12-dT18 and eight model proteins (ribonuclease A, insulin, cytochrome c, lysocyme, alpha-lactalbumin, alpha-chymotrypsinogen, beta-lactoglobulin B, catalase) were studied. Also, the role of additional phosphine on the entire polymerization setup and the associated chromatographic separations was elucidated. Relevant chromatographic data as well as differences between the separation of oligodeoxynucleotides and proteins may directly be attributed to the above-mentioned physicochemical properties of the metathesis-based monoliths. Finally, DSC-TGA-MS investigations on various monoliths of different composition and age were carried out in order to provide information on stability and oxidation behavior.

Lack of sequence variation in sporadic bovine leucosis in regions of tumour suppressor genes p53 and p16

Regions of the promoter and exons 5-8 of the tumour suppressor gene p53 were analysed in 25 cases of sporadic bovine leucosis. The study included 17 cases of juvenile leucosis, five cases of adult leucosis and three cases of skin leucosis. Exon 2 of tumour suppressor gene p16 was also investigated in the same samples. No sequence variations were present in the analysed areas of the genes. In p53, this fact represents a clear difference in comparison with enzootic bovine leucosis. In p16, no comparative data are available.

Transcriptional regulation by the phosphorylation-dependent factor CREB

The transcription factor CREB -- for 'cyclic AMP response element-binding protein' -- functions in glucose homeostasis, growth-factor-dependent cell survival, and has been implicated in learning and memory. CREB is phosphorylated in response to various signals, but how is specificity achieved in these signalling pathways?

Familial isolated parathyroid adenoma in a consanguineous family

The 23-year-old Caucasian male propositus presented with symptomatic hypercalcemia, hypophosphatemia and normocalciuria for 2 months. His 29-year-old brother had undergone an operation for recurrent parathyroid adenoma at age 26 and 28. No other member of the family was affected. His father and mother were second-degree relatives. Laboratory studies showed primary hyperparathyroidism (pHPT), while the remaining endocrine studies and genetic testing for multiple endocrine neoplasia 1 and 2A were normal. Technetium-cardiolite scintigraphy and ultrasound scans revealed a parathyroid mass at the left lower neck. Apart from bilateral hearing loss due to gentamicin treatment as a pre-term child, the patient was in of good health. Signs or symptoms of other endocrinopathies were absent. The patient was referred for parathyroidectomy with subsequent autotransplantation of the remaining glands into his sternocleidomastoid muscle. Histological examination revealed an adenoma with oncocytic differentiation, similar to that seen in his brother. The disease may follow a recessive mode of inheritance or may be due to a dominant germ-cell mutation in one of the parents. The presented case may ultimately help in elucidating the molecular genetic basis of this rare form of pHPT.

Comparative analysis of ras proto-oncogene mutations in selected mammalian tumors

Point mutations within ras proto-oncogenes are frequently detected in human malignancies and in different types of experimentally induced tumors in animals. In contrast to findings in experimental animal models of carcinogenesis, little is known about the incidence of ras mutations in naturally occurring animal tumors. In the present study, we investigated whether point mutations, particularly within the mutational hot-spot codons 12, 13, and 61, occur at comparable frequencies in human malignancies and spontaneously occurring tumors in other mammalian species. Two hundred seventy-nine of the most frequent canine and feline neoplasms were analyzed for changes in mutational hot-spot regions of the N-, Ki-, and Ha-ras genes. DNA fragments from exons 1 and 2 of all three ras genes were amplified by polymerase chain reaction, and the presence of point mutations was assessed by single-strand conformation polymorphism analysis and direct sequencing of amplified products. Only one sample, a case of canine melanoma, exhibited an Ha-ras mutation. Thus, our data strongly suggested that ras mutations at the hot-spot loci are apparently very rare and do not play a major role in the pathogenesis of the spontaneously occurring canine and feline tumors investigated. These observations were in marked contrast to those in experimental rodent models of carcinogen-induced mammary and skin tumors that described a consistent association with Ha- or Ki-ras activation. The role of ras oncogene activation in related human malignancies therefore cannot be readily inferred from studies of experimental carcinogenesis in animal models.