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Ahler JR, Busk H, Holm PM, Bricca A, Poulsen DV, Skou ST, Tang LH. Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis. Prev Med 2024; 183:107966. [PMID: 38641081 DOI: 10.1016/j.ypmed.2024.107966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases. METHODS We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE. RESULTS From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low. CONCLUSION Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA.
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Affiliation(s)
- Jonas R Ahler
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Henriette Busk
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands
| | - Alessio Bricca
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Dorthe V Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Joshi VL, Borregaard B, Mikkelsen TB, Tang LH, Nordström EB, Bruvik SM, Wieghorst A, Zwisler AD, Wagner MK. Observer-reported cognitive decline in out-of-hospital cardiac arrest survivors and its association with long-term survivor and relative outcomes. Resuscitation 2024; 197:110162. [PMID: 38452993 DOI: 10.1016/j.resuscitation.2024.110162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/04/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
AIM Long-term cognitive decline after out-of-hospital cardiac arrest (OHCA) is still poorly understood. This study describes long-term observer-reported cognitive decline among Danish OHCA survivors, including differences in years since the event, and investigates characteristics and self-reported outcomes associated with observer-reported cognitive decline. METHODS Adults who survived an OHCA from 2016 to 2019, and their relatives, completed the national DANish Cardiac Arrest Survivorship survey. Relatives completed the Informant Questionnaire on Cognitive Decline in the Elderly, Cardiac Arrest version (IQCODE-CA), the Hospital Anxiety and Depression Scale (HADS) and the World Health Organisation-Five Well-being index; and survivors completed the Two Simple Questions (everyday activities and mental recovery), the Modified Fatigue Impact Scale, HADS, and the Short World Health Organisation Disability Assessment Schedule 2.0. Potential associations between survivor characteristics and the IQCODE-CA were investigated using a multivariable logistic regression model. Self-reported outcomes among survivors and relatives, and the association with IQCODE-CA scores were investigated using separate logistic regression models. RESULTS Total median IQCODE-CA score was 3.04 (IQR: 3.00-3.27), with 47% having possible cognitive decline (score ≥ 3.04), consistent across time groups. Increasing age (OR 0.98, 95% CI: 0.97-0.99) and worse self-reported mental and physical outcomes for survivors and relatives, except 'everyday activities' were significantly associated with possible cognitive decline among survivors. CONCLUSIONS Nearly half of OHCA survivors may suffer long-term cognitive decline. Worse self-reported mental and physical outcomes among survivors and their relatives are associated with potential cognitive decline emphasising the need for post-OHCA care to include systematic neurocognitive assessment, tailored support and effective rehabilitation.
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Affiliation(s)
- Vicky L Joshi
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.
| | - Britt Borregaard
- Department of Clinical Research, University of Southern Denmark Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Tina Broby Mikkelsen
- Department of Clinical Research, University of Southern Denmark Odense, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals & The Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Erik Blennow Nordström
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics), Skåne University Hospital, Sweden
| | | | - Anders Wieghorst
- Department of Clinical Research, University of Southern Denmark Odense, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Clinical Research, University of Southern Denmark Odense, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Joshi VL, Juel K, Thuesen J, Backmann T, Winge K, Tang LH, Zwisler AD, Mikkelsen TB. Identifying the prevalence of Parkinson's disease in Denmark using healthcare registries and self-reported survey data. Parkinsonism Relat Disord 2024; 120:106011. [PMID: 38246106 DOI: 10.1016/j.parkreldis.2024.106011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Existing estimates of PD prevalence in Denmark are lower than those in the rest of Europe and are based on identification via single registries. Hence, are aim was to use a combined registry/self-report survey approach to identify people with PD and also investigate whether using different registry methods led to differences in the accuracy, completeness and characteristics of the identified cohorts. METHODS This study had a cross-sectional design using routinely collected health registry data to identify adults, ≥18 years of age and resident in Denmark, with PD from either the Danish National Patient (DNP) registry or Danish Prescription Medicines (DPM) registry. Those identified were asked to confirm their PD diagnosis using a national self-report survey. RESULTS 13,433 people were identified potentially as having PD via the DNP or DPM registry and sent a survey. Of these, 9094 responded (68 %) of which 85 % confirmed they had PD (n = 7763; 194/100,000; 95%CI:7650-7876). When adjusting for non-respondents, assuming an equal rate of confirmation in respondents and non-respondents, estimated Danish PD population was 11,467 (198.4/100,000; 95 % CI:197.2-199.6). Identification of people using those found in both registries led to 98 % confirming they had PD versus using one registry: DNP 93 % and DPM 88 %. No clear differences in sociodemographic characteristics were found between different registry identification methods. CONCLUSIONS Estimated PD population in Denmark was significantly higher than previous Danish estimates and close to existing estimates in other European countries. The most accurate PD population was identified when including those found in both the DNP and DPM registries.
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Affiliation(s)
- Vicky L Joshi
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - Knud Juel
- Institute of Public Health, University of Southern Denmark, Denmark
| | - Jette Thuesen
- Unit for User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Denmark
| | - Tina Backmann
- Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Denmark
| | - Kristian Winge
- Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, 2400, Copenhagen NW, Denmark
| | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina B Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hamborg TG, Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Simonÿ C, Grøntved A, Brønd JC, Soja AMB, Tang LH. mHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study. Digit Health 2024; 10:20552076241239243. [PMID: 38495859 PMCID: PMC10943751 DOI: 10.1177/20552076241239243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme. Methods The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers. Results Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported. Conclusion Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation.
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Affiliation(s)
- Trine G Hamborg
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Rune M Andersen
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mikkel B Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Madalina Jäger
- Danish Center for Motivation and Behaviour Change, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan C Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne M B Soja
- Department of Medicine 1, Section of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Roikjær SG, Skou ST, Walløe S, Tang LH, Beck M, Simonÿ C, Asgari N. Experiences of integrating and sustaining physical activity in life with multiple sclerosis, Alzheimer's disease, and ischaemic heart disease: a scoping review. Disabil Rehabil 2023:1-10. [PMID: 37584422 DOI: 10.1080/09638288.2023.2244424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE The effects of physical activity on health are well-established for chronic diseases such as multiple sclerosis (MS), Alzheimer's disease (AD), and ischaemic heart disease (IHD). However, sustaining physical activity in everyday life is difficult. Lifeworld knowledge can help qualify interventions aimed at resolving this public health issue, but there is a gap in regard to synthesized research on peoples' experiences with integrating and sustaining physical activity. Hence, the purpose of this review is to explore and present the available evidence on experiences with integrating and sustaining physical activity in a lived life with MS, AD, and IHD. METHODS We conducted a scoping review with qualitative analysis and narrative syntheses in accordance with PRISMA-ScR. Based on SPIDER we ran a systematic search in Cinahl, Embase, Medline, and PsychInfo for primary qualitative research papers published until December 2022. RESULTS 43 papers were included. A thematic content analysis found that individuals who have MS, AD or IHD find integrating and sustaining physical activity in everyday life meaningful on several levels: Physical activity can facilitate meaningful movement with outcomes of physical, psychosocial, and existential importance. CONCLUSION The research literature presents a meaning to physical activity that extends the idea of physical fitness to one of existential movement and personal growth. In addition, our review finds that people are more likely to integrate and sustain physical activity if they feel acknowledged, supported and believe that physical activity has a meaningful purpose reflecting their sense of self. Taking a more person-centred approach in rehabilitative care might help qualify the content of physical activity in terms of integration into everyday life, but more research is needed on how to implement a person-centred approach in practice.IMPLICATIONS FOR REHABILITATIONThe research literature presents an experiential meaning to physical activity that extends the idea of physical fitness to one of more existential movement and personal growth.To ensure the integration of physical activity in people's everyday life, future rehabilitation interventions might benefit from adapting a more person-centred approach.People are more likely to sustain physical activity when they feel acknowledged, supported through social relationships, can access activities adapted to their specific needs and preferences, and believe that physical activity has a meaningful purpose reflecting their sense of self.
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Affiliation(s)
- Stine G Roikjær
- Department of Neurology Næstved, Slagelse and Ringsted Hospitals, CNF, the Center for Neurological Research, Slagelse, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sisse Walløe
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- The Research Unit OPEN, Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Malene Beck
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nasrin Asgari
- Department of Neurology Næstved, Slagelse and Ringsted Hospitals, CNF, the Center for Neurological Research, Slagelse, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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Dibben GO, Hillsdon M, Dalal HM, Tang LH, Doherty PJ, Taylor R. Home-based cardiac rehabilitation and physical activity in people with heart failure: a secondary analysis of the REACH-HF randomised controlled trials. BMJ Open 2023; 13:e063284. [PMID: 36759035 PMCID: PMC9923308 DOI: 10.1136/bmjopen-2022-063284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To quantify the impact of a home-based cardiac rehabilitation intervention (Rehabilitation Enablement in Chronic Heart Failure (REACH-HF)) on objectively assessed physical activity (PA) of patients with heart failure (HF) and explore the extent by which patient characteristics are associated with a change in PA. DESIGN Secondary analysis of randomised controlled trial data. SETTING Five centres in the UK. PARTICIPANTS 247 patients with HF (mean age 70.9±10.3 years; 28% women). INTERVENTIONS REACH-HF versus usual care (control). PRIMARY AND SECONDARY OUTCOME MEASURES PA was assessed over 7 days via GENEActiv triaxial accelerometer at baseline (pre-randomisation), post-intervention (4 months) and final follow-up (6-12 months). Using HF-specific intensity thresholds, intervention effects (REACH-HF vs control) on average min/day PA (inactivity, light PA and moderate-to-vigorous PA (MVPA)) over all days, week days and weekend days were examined using linear regression analysis. Multivariable regression was used to explore associations between baseline patient characteristics and change in PA. RESULTS Although there was no difference between REACH-HF and control groups in 7-day PA levels post-intervention or at final follow-up, there was evidence of an increase in weekday MVPA (10.9 min/day, 95% CI: -2.94 to 24.69), light PA (26.9 min/day, 95% CI: -0.05 to 53.8) and decreased inactivity (-38.31 min/day, 95% CI: -72.1 to -4.5) in favour of REACH-HF. Baseline factors associated with an increase in PA from baseline to final follow-up were reduced MVPA, increased incremental shuttle walk test distance, increased Hospital Anxiety and Depression Scale anxiety score and living with a child >18 years (p<0.05). CONCLUSIONS While participation in the REACH-HF home-based cardiac rehabilitation intervention did not increase overall weekly activity, patient's behaviour patterns appeared to change with increased weekday PA levels and reduced inactivity. Baseline PA levels were highly predictive of PA change. Future focus should be on robust behavioural changes, improving overall levels of objectively assessed PA of people with HF. TRIAL REGISTRATION NUMBERS ISRCTN78539530 and ISRCTN86234930.
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Affiliation(s)
- Grace O Dibben
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Melvyn Hillsdon
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, Devon, UK
| | - Hasnain M Dalal
- Research, Development and Innovation, Royal Cornwall Hospitals NHS Trust, TRURO, Cornwall, UK
- Primary Care, University of Exeter Medical School, Truro, UK
| | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Sjaelland, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | | | - Rod Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Damlund ARS, Jørgensen LB, Blume B, Skou ST, Tang LH, Møller T. Reasons for dropout in the transition from hospital to municipality during exercise-based cardiac rehabilitation in a Danish cross-sectorial setting: a qualitative study. BMJ Open 2022; 12:e064660. [PMID: 36446448 PMCID: PMC9710337 DOI: 10.1136/bmjopen-2022-064660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Despite documented benefits of cardiac rehabilitation (CR), attrition rates remain relatively high. Insights on patient perspectives concerning dropout during transition phases are deficient. This deeper understanding may help to inform on the perceived benefits and barriers in CR. This qualitative study explores the reasons why patients' dropout during the transition from a hospital-based CR programme to local healthcare facilities. SETTING A Danish hospital and seven local healthcare centres. PARTICIPANTS Twelve patients, who had dropped out of exercise-based cardiac rehabilitation (exCR) during the transition from hospital-based rehabilitation to local healthcare centres, were recruited to semistructured interviews based on a purposeful sampling. RESULTS Important patient needs during rehabilitation was the ability to identify and reflect oneself in a group of peers in a safe, specialised hospital-based environment. At the transition point, the meaningfulness of continuation of CR was revaluated. Findings showed that reasons for discontinuation varied within individuals. It encompassed on a balanced choice of reassessing benefits against competing agendas as work demands versus expectations of benefits in a changed exercise environment and own exercise capabilities. CONCLUSION The study indicated that patient needs as timely relevance, a specialised safe environment and peer support are significant for participation in exCR. These needs may change during the transition stage due to competing agendas as work obligations and assessment of own ability to take control themselves. Perceived meaningfulness may be a major motivational driver for both initiating and making a judiciously choice of leaving an exCR programme.
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Affiliation(s)
| | - Lars Bo Jørgensen
- Department of Occupational Therapy and Physiotherapy, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved, Slagelse, Ringsted Hospital, Slagelse Hospital, Slagelse, Sjaelland, Denmark
| | - Birgitte Blume
- Department of Occupational Therapy and Physiotherapy, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Sjaelland, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Tom Møller
- The University Hospitals Centre for Health Research (UCSF), Department 9701, Copenhagen University Hospital, Copenhagen, Denmark
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Bloomquist K, Tang LH, Kjelsbak S, Hansen LL, Christensen J. National mapping of municipality-based rehabilitation services for patients recovering from COVID-19 in Denmark: a cross-sectional study. International Journal of Therapy and Rehabilitation 2022. [DOI: 10.12968/ijtr.2021.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background/aims A lack of knowledge exists as to how municipalities are meeting the rehabilitation needs of patients recovering from COVID-19. This poses a potential barrier when referring patients for rehabilitation. The aim of this study was to map and describe municipality-based rehabilitation services for patients recovering from COVID-19 in Denmark. Methods This was a cross-sectional, nation-wide survey. Key staff members from all 98 municipalities in Denmark were invited to participate. Participants had insight into the organisation and professional content of municipal rehabilitation. Structured telephone interviews were conducted by three interviewers between October and November 2020. The interview guide consisted of items that asked about the availability, content and organisation of municipality-based rehabilitation services. Results A total of 91 municipalities (93% response rate) participated in the study. Rehabilitation could be provided within pre-existing services in 98% of municipalities and 93% systematically assessed individual rehabilitation needs using a variety of measurement methods. All municipalities reported that they had services in place to provide functional rehabilitation (eg gait training) and over 90% provided physical, cognitive and lifestyle-related rehabilitation. In contrast, 70% could provide COVID-19 education and 64% psychological therapy. Overall, 32% of municipalities had not received referrals for COVID-19 rehabilitation. Of the 62 municipalities that had COVID-19 rehabilitation experience, 73% rated the degree to which they could deliver coherent and coordinated rehabilitation for patients with complex rehabilitation needs as high or very high. Conclusions Overall, Danish municipalities reported that pre-existing services are in place to provide relevant, individualised rehabilitation for patients recovering from COVID-19. Nonetheless, future efforts should ensure that patient education is established, in step with health care providers accumulating knowledge, as well as integrated referral pathways between sectors, to deliver rehabilitation to patients with complex needs. Further, implementation of a national data collection strategy would strengthen and inform future development of relevant services both nationally and internationally.
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Affiliation(s)
- Kira Bloomquist
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sissel Kjelsbak
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Linea L Hansen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Tang LH, Xiong Y, Fang L, Bian C, Zhang Q. [Occupational stress of air traffic controllers and its influencing factors]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:668-673. [PMID: 36229211 DOI: 10.3760/cma.j.cn121094-20201225-00717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the occupational stress status of air traffic controllers (ATC) and analyze its influencing factors. Methods: By using cluster sampling method, 457 ATCs in an air traffic management bureau were selected as the investigation objects. The job content questionnaire (JCQ) and the effort reward imbalance questionnaire (ERI) were used to measure work requirements independent imbalance type and ERI type occupational stress separately and analyze the influencing factors. Results: Of the 457 ATCs, 81.84% (374/457) ATGs had work requirements independent imbalance type of occupational stress and 84.46% (386/457) ATGs had ERI type occupational stress. Univariate analysis showed that the factors of marital status, degree of education, age, length of service, title, job post, family monthly income, views on regular training, occurrence of emergency or unsafe events in last month and monthly night shift frequency had various degrees of influence on the different factor scores of JCQ and ERI (P<0.01) . Logistic regression analysis showed that the level of JCQ type occupational stress of ATCs with junior titles and probationers was higher than those of intermediate/senior titles (P=0.000, 0.000) ; The ERI type occupational stress of probationers and junior titles ATCs was lower than those with intermediate/senior titles (P=0.000) . The ERI and JCQ type occupational stress level of tower post ATCs was higher than that of other two job post ATCs (P=0.001, 0.000, 0.000, 0.000) . The ATCs considering regular training had more disadvantages than advantages showed lower ERI type occupational stress level than those considering more advantages than disadvantages (P=0.000) . The ERI type occupational stress level of ATCs who experienced emergency or unsafe events in last month was higher than those who didn't (P=0.007) . Conclusion: A large proportion of ATCs had occupational stress. Management should adjust its policies and pay were attention to occupational stress of ATLs.
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Affiliation(s)
- L H Tang
- Civil Aviation Management Institute of China,Beijing 100102, China
| | - Y Xiong
- Qinhuangdao Airport Branch of Hebei Airport Management Group Co. Ltd, Qinhuangdao 066000, China
| | - L Fang
- Qinhuangdao Airport Branch of Hebei Airport Management Group Co. Ltd, Qinhuangdao 066000, China
| | - C Bian
- China Aviation Fuel Co. Ltd. Office in PetroChina North China Petrochemical Branch, Renqiu 062550, China
| | - Q Zhang
- Northwest Region Air Traffic Management Bureau of Civil Aviation of China, Xi'an 710082, China
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Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Grøntved A, Brønd JC, Soja AMB, Tang LH. Maintenance of physical activity after cardiac rehabilitation (FAIR): study protocol for a feasibility trial. BMJ Open 2022; 12:e060157. [PMID: 35383088 PMCID: PMC8984013 DOI: 10.1136/bmjopen-2021-060157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To enhance health and prevent secondary consequences for patients with cardiovascular disease (CVD), maintenance of an active lifestyle following participation in cardiac rehabilitation (CR) is important. However, levels of physical activity often decrease after completion of a structured CR programme. Models that support long-term behaviour change with a sustained level of physical activity are imperative. The aim of this study is to evaluate the feasibility of a mobile health intervention based on the Health Action Process Approach theoretical model of behaviour change in patients with CVD for 3 months after completion of a CR programme. METHODS AND ANALYSIS In a feasibility trial design, we will recruit 40 participants from CR programmes at Slagelse Hospital, the City of Slagelse (municipality), or Holbæk Hospital. After completing the standard structured CR programme, each participant will create an action plan for physical activity together with a physiotherapist. Following that, participants are sent 2 weekly text messages for 3 months. The first text message prompts physical activity, and the second will check if the action plan has been followed. If requested by participants, a coordinator will call and guide the physical activities behaviour. The feasibility of this maintenance intervention is evaluated based on predefined progression criteria. Physical activity is measured with accelerometers at baseline and at 3 months follow-up. ETHICS AND DISSEMINATION Study approval was waived (EMN-2021-00020) by the Research Ethics Committee of Region Zealand, Denmark. Study results will be made public and findings disseminated to patients, health professionals, decision-makers, researchers and the public. TRIAL REGISTRATION NUMBER NCT05011994.
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Affiliation(s)
- Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren Thorgaard Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Nissen N, Holm PM, Bricca A, Dideriksen M, Tang LH, Skou ST. Clinicians' beliefs and attitudes to physical activity and exercise therapy as treatment for knee and/or hip osteoarthritis: a scoping review. Osteoarthritis Cartilage 2022; 30:260-269. [PMID: 34800632 DOI: 10.1016/j.joca.2021.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore clinicians' attitudes and beliefs about physical activity and exercise therapy as treatment for individuals with knee and/or hip osteoarthritis (OA). METHOD This was a scoping review, mapping available knowledge about the topic derived from qualitative research designs and methods. A comprehensive search of selected databases (MEDLINE, EMBASE; CINAHL; Web of Science) was conducted and data were analysed thematically. RESULTS Twelve articles met inclusion criteria. Thematic analysis identified three interrelated main themes: 1) Understandings of OA and its trajectory and management; 2) Attitudes to activity and exercise as part of OA management; 3) Clinicians' perceived knowledge of and expertise in OA management. Findings highlight that many clinicians involved in knee/hip OA management, particularly general practitioners and physiotherapists, perceive OA to be a low priority 'wear-and-tear' disease with expected progression of symptoms, making joint replacement surgery eventually inevitable. Further, many clinicians appear to lack knowledge about and interest in physical activity and exercise therapy in the management of knee/hip OA, and seem to show uncertainty about the effectiveness and safety of physical activity and exercise therapy on joint health. CONCLUSION Clinicians' attitudes and beliefs about physical activity and exercise therapy in OA seem to reflect an outdated narrative which describes OA as a wear-and-tear disease with inevitable disease progression to joint replacement surgery. Clinicians need to adopt a contemporary narrative, which accurately reflects current knowledge and evidence-based practice, thereby ensuring consistent utilisation of exercise therapy as first-line care as recommended in OA guidelines.
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Affiliation(s)
| | - P M Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - M Dideriksen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - S T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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12
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Tang LH, Andreasson KH, Thygesen LC, Jepsen R, Møller A, Skou ST. Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study. J Multimorb Comorb 2022; 12:26335565221128712. [PMID: 36386291 PMCID: PMC9659769 DOI: 10.1177/26335565221128712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together. METHOD Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18 years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6 months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5. RESULTS Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site. CONCLUSION The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.
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Affiliation(s)
- Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Karen H Andreasson
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F., Denmark
| | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Joshi VL, Christensen J, Lejsgaard E, Taylor RS, Zwisler AD, Tang LH. Effectiveness of rehabilitation interventions on the secondary consequences of surviving a cardiac arrest: a systematic review and meta-analysis. BMJ Open 2021; 11:e047251. [PMID: 34475160 PMCID: PMC8413927 DOI: 10.1136/bmjopen-2020-047251] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM The aim of this systematic review was to assess the effectiveness of rehabilitation interventions on the secondary physical, neurological and psychological consequences of cardiac arrest (CA) for adult survivors. METHODS A literature search of electronic databases (MEDLINE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Psychological Information Database, Web of Science and Cochrane Central Register of Controlled trials) was conducted for randomised controlled trials (RCTs) and observational studies up to 18 April 2021. The primary outcome was health-related quality of life (HRQoL) and main secondary outcome was neurological function with additional secondary outcomes being survival, rehospitalisation, safety (serious and non-serious adverse events), psychological well-being, fatigue, exercise capacity and physical capacity. Two authors independently screened studies for eligibility, extracted data and assessed risk of bias. RESULTS Three RCTs and 11 observational studies were included (total 721 participants). Study duration ranged from 8 weeks to 2 years. Pooled data from two RCTs showed low-quality evidence for no effect on physical HRQoL (standardised mean difference (SMD) 0.19, (95% CI: -0.09 to 0.47)) and no effect on mental HRQoL (SMD 0.27 (95% CI: -0.01 to 0.55)).Regarding secondary outcomes, very low-quality evidence was found for improvement in neurological function associated with inpatient rehabilitation for CA survivors with acquired brain injury (SMD 0.71, (95% CI: 0.45 to 0.96)) from five observational studies. Two small observational studies found exercise-based rehabilitation interventions to be safe for CA survivors, reporting no serious or non-serious events. CONCLUSIONS Given the overall low quality of evidence, this review cannot determine the effectiveness of rehabilitation interventions for CA survivors on HRQoL, neurological function or other included outcomes, and recommend further high-quality studies be conducted. In the interim, existing clinical guidelines on rehabilitation provision after CA should be followed to meet the high burden of secondary consequences suffered by CA survivors. PROSPERO REGISTRATION NUMBER CRD42018110129.
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Affiliation(s)
- Vicky L Joshi
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Jan Christensen
- Department of Occupational- and Physiotherapy, Copenhagen University Hospital, København, Denmark
| | - Esben Lejsgaard
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Rod S Taylor
- 3MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Sjaelland, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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14
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Abraham LN, Sibilitz KL, Berg SK, Tang LH, Risom SS, Lindschou J, Taylor RS, Borregaard B, Zwisler AD. Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database Syst Rev 2021; 5:CD010876. [PMID: 33962483 PMCID: PMC8105032 DOI: 10.1002/14651858.cd010876.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The impact of exercise-based cardiac rehabilitation (CR) following heart valve surgery is uncertain. We conducted an update of this systematic review and a meta-analysis to assess randomised controlled trial evidence for the use of exercise-based CR following heart valve surgery. OBJECTIVES To assess the benefits and harms of exercise-based CR compared with no exercise training in adults following heart valve surgery or repair, including both percutaneous and surgical procedures. We considered CR programmes consisting of exercise training with or without another intervention (such as an intervention with a psycho-educational component). SEARCH METHODS We searched the Cochrane Central Register of Clinical Trials (CENTRAL), in the Cochrane Library; MEDLINE (Ovid); Embase (Ovid); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO); PsycINFO (Ovid); Latin American Caribbean Health Sciences Literature (LILACS; Bireme); and Conference Proceedings Citation Index-Science (CPCI-S) on the Web of Science (Clarivate Analytics) on 10 January 2020. We searched for ongoing trials from ClinicalTrials.gov, Clinical-trials.com, and the World Health Organization International Clinical Trials Registry Platform on 15 May 2020. SELECTION CRITERIA We included randomised controlled trials that compared exercise-based CR interventions with no exercise training. Trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and had received heart valve replacement or heart valve repair. Both percutaneous and surgical procedures were included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluating risk domains using the 'Risk of bias' (RoB2) tool. We assessed clinical and statistical heterogeneity. We performed meta-analyses using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence for primary outcomes (all-cause mortality, all-cause hospitalisation, and health-related quality of life). MAIN RESULTS We included six trials with a total of 364 participants who have had open or percutaneous heart valve surgery. For this updated review, we identified four additional trials (216 participants). One trial had an overall low risk of bias, and we classified the remaining five trials as having some concerns. Follow-up ranged across included trials from 3 to 24 months. Based on data at longest follow-up, a total of nine participants died: 4 CR versus 5 control (relative risk (RR) 0.83, 95% confidence interval (CI) 0.26 to 2.68; 2 trials, 131 participants; GRADE quality of evidence very low). No trials reported on cardiovascular mortality. One trial reported one cardiac-related hospitalisation in the CR group and none in the control group (RR 2.72, 95% CI 0.11 to 65.56; 1 trial, 122 participants; GRADE quality of evidence very low). We are uncertain about health-related quality of life at completion of the intervention in CR compared to control (Short Form (SF)-12/36 mental component: mean difference (MD) 1.28, 95% CI -1.60 to 4.16; 2 trials, 150 participants; GRADE quality of evidence very low; and SF-12/36 physical component: MD 2.99, 95% CI -5.24 to 11.21; 2 trials, 150 participants; GRADE quality of evidence very low), or at longest follow-up (SF-12/36 mental component: MD -1.45, 95% CI -4.70 to 1.80; 2 trials, 139 participants; GRADE quality of evidence very low; and SF-12/36 physical component: MD -0.87, 95% CI -3.57 to 1.83; 2 trials, 139 participants; GRADE quality of evidence very low). AUTHORS' CONCLUSIONS: Due to lack of evidence and the very low quality of available evidence, this updated review is uncertain about the impact of exercise-CR in this population in terms of mortality, hospitalisation, and health-related quality of life. High-quality (low risk of bias) evidence on the impact of CR is needed to inform clinical guidelines and routine practice.
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Affiliation(s)
- Lizette N Abraham
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Kirstine L Sibilitz
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Selina K Berg
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars H Tang
- The research unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Signe S Risom
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- The Heart Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute for Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Britt Borregaard
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Joshi VL, Tang LH, Borregaard B, Zinckernagel L, Mikkelsen TB, Taylor RS, Christiansen SR, Nielsen JF, Zwisler AD. Long-term physical and psychological outcomes after out-of-hospital cardiac arrest-protocol for a national cross-sectional survey of survivors and their relatives (the DANCAS survey). BMJ Open 2021; 11:e045668. [PMID: 33811056 PMCID: PMC8023731 DOI: 10.1136/bmjopen-2020-045668] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The number of out-of-hospital cardiac arrest (OHCA) survivors is increasing. However, there remains limited knowledge on the long-term physical and psychological problems suffered by survivors and their relatives. The aims of the DANCAS (DANish cardiac arrest survivorship) survey are to describe the prevalence of physical and psychological problems, identify predictors associated with suffering them and to determine unmet rehabilitation needs in order to make recommendations on the timing and content of future rehabilitation interventions. METHODS AND ANALYSIS The DANCAS survey has a cross-sectional design involving a survey of OHCA survivors and their relatives. OHCA survivors will be identified through the Danish Cardiac Arrest Registry as having suffered an OHCA between 1 January 2016 and 31 December 2019. Each survivor will be asked to identify their closest relative to complete the relatives' survey. Contents of survivor survey: EQ-5D-5Level, Hospital Anxiety and Depression Scale, Two Simple Questions, Modified Fatigue Impact Scale, 12-item WHO Disability Assessment Scale 2.0, plus questions on unmet rehabilitation and information needs. Contents of relatives' survey: World Health Organisation-Five Well-Being Index, Hospital Anxiety and Depression Scale, Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest and the Modified Caregiver Strain Index. Self-report outcome data collected through the surveys will be enriched by data from Danish national registries including demographic characteristics, circumstances of cardiac arrest and comorbidities. The survey will be completed either electronically or by post December 2020-February 2021. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. Surveys and registry-based research studies do not normally require ethical approval in Denmark. This has been confirmed for this study by the Region of Southern Denmark ethics committee (20192000-19). Results of the study will be disseminated via several peer-reviewed publications and will be presented at national and international conferences.
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Affiliation(s)
- Vicky L Joshi
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Line Zinckernagel
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tina Broby Mikkelsen
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Sofie Raahauge Christiansen
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Ann Dorthe Zwisler
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Wagner MK, Berg SK, Tang LH, Stenbaek DS, Hassager C, Missel M. Understanding the lived experiences of short- and long-term consequences on daily life after out-of-hospital cardiac arrest. A focus group study. J Adv Nurs 2020; 77:1442-1452. [PMID: 33314377 DOI: 10.1111/jan.14707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/20/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore and gain in-depth understanding of how out-of-hospital cardiac arrest survivors experience the short- and long-term consequences on daily life. DESIGN A qualitative exploratory design. METHODS A purposive sample of 32 survivors of out-of-hospital cardiac arrest. Data from six audiotaped focus group interviews were collected in either November 2018 or in March 2019. Analysis and interpretation of the transcribed texts was performed using a phenomenological-hermeneutic approach guided by Ricoeur for unfolding lived experiences. RESULTS Three narratives were identified. The survivors narrated how they in the early phase after the cardiac arrest experienced: (a) 'a fragmented memory at the mercy of the system'. The analysis further showed how the participants were: (b) 'living in the shadow of anxiety and mixed feelings' and with the: (c) 'lost sense of self' up to several years after survival. CONCLUSION The participants in our study experienced distinct bodily impairments, suffering, and the lost sense of self in the return to daily life from early on to several years after resuscitation. There seem to be an urgent need for an early initiated post-arrest transitional care program led by an expert cardiac arrest nurse. In particular, the healthcare professionals need to pay attention to survivors in employment and with children living at home. Facilitated cardiac arrest peer support groups might minimize the long-term suffering, heighten the self-image, and install a new hope for the future. IMPACT To ease the post-arrest return to daily life for out-of-hospital cardiac arrest survivors it seems important that a transitional care program from the inhospital setting to the community consist of: (a) screening for and education on bodily losses at an early stage, (b) provision of support on the often prolonged emotional reactions, and (c) referring for further individual and targeted psychological and neurological follow-up and rehabilitation if needed.
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Affiliation(s)
- Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Southern Denmark University, Nyborg, Denmark
| | - Selina K Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars H Tang
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Southern Denmark University, Nyborg, Denmark
| | - Dea S Stenbaek
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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17
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Dibben GO, Gandhi MM, Taylor RS, Dalal HM, Metcalf B, Doherty P, Tang LH, Kelson M, Hillsdon M. Physical activity assessment by accelerometry in people with heart failure. BMC Sports Sci Med Rehabil 2020; 12:47. [PMID: 32817798 PMCID: PMC7425563 DOI: 10.1186/s13102-020-00196-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/24/2020] [Indexed: 12/24/2022]
Abstract
Background International guidelines for physical activity recommend at least 150 min per week of moderate-to-vigorous physical activity (MVPA) for adults, including those with cardiac disease. There is yet to be consensus on the most appropriate way to categorise raw accelerometer data into behaviourally relevant metrics such as intensity, especially in chronic disease populations. Therefore the aim of this study was to estimate acceleration values corresponding to inactivity and MVPA during daily living activities of patients with heart failure (HF), via calibration with oxygen consumption (VO2) and to compare these values to previously published, commonly applied PA intensity thresholds which are based on healthy adults. Methods Twenty-two adults with HF (mean age 71 ± 14 years) undertook a range of daily living activities (including laying down, sitting, standing and walking) whilst measuring PA via wrist- and hip-worn accelerometers and VO2 via indirect calorimetry. Raw accelerometer output was used to compute PA in units of milligravity (mg). Energy expenditure across each of the activities was converted into measured METs (VO2/resting metabolic rate) and standard METs (VO2/3.5 ml/kg/min). PA energy costs were also compared with predicted METs in the compendium of physical activities. Location specific activity intensity thresholds were established via multilevel mixed effects linear regression and receiver operator characteristic curve analysis. A leave-one-out method was used to cross-validate the thresholds. Results Accelerometer values corresponding with intensity thresholds for inactivity (< 1.5METs) and MVPA (≥3.0METs) were > 50% lower than previously published intensity thresholds for both wrists and waist accelerometers (inactivity: 16.7 to 18.6 mg versus 45.8 mg; MVPA: 43.1 to 49.0 mg versus 93.2 to 100 mg). Measured METs were higher than both standard METs (34–35%) and predicted METs (45–105%) across all standing and walking activities. Conclusion HF specific accelerometer intensity thresholds for inactivity and MVPA are lower than previously published thresholds based on healthy adults, due to lower resting metabolic rate and greater energy expenditure during daily living activities for HF patients. Trial registration Clinical trials.gov NCT03659877, retrospectively registered on September 6th 2018.
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Affiliation(s)
- Grace O Dibben
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Manish M Gandhi
- Department of Cardiology, Royal Devon & Exeter Hospital, Exeter, UK
| | - Rod S Taylor
- Institute of Health Research (Primary Care), University of Exeter Medical School, St. Luke's Campus, Exeter, UK.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hasnain M Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Institute of Health Research (Primary Care), University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Brad Metcalf
- Department of Sport and Health Sciences, University of Exeter, St Luke's Campus, Exeter, UK
| | | | - Lars H Tang
- National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Ringsted, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mark Kelson
- Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Melvyn Hillsdon
- Department of Sport and Health Sciences, University of Exeter, St Luke's Campus, Exeter, UK
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18
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Tang LH, Joshi V, Egholm CL, Zwisler AD. Are survivors of cardiac arrest provided with standard cardiac rehabilitation? - Results from a national survey of hospitals and municipalities in Denmark. Eur J Cardiovasc Nurs 2020; 20:115-123. [PMID: 33849060 DOI: 10.1177/1474515120946313] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
AIM To quantify the provision of standard cardiac rehabilitation to Danish survivors of cardiac arrest at a programme level, and to analyse whether organizational factors influenced the provision. METHOD We mapped the provision of cardiac rehabilitation core components to survivors of cardiac arrest and compared this with a reference group of patients after acute myocardial infarction using data from a cross-sectional programme-level survey among all hospitals (n = 34) and municipalities (n = 98) in Denmark. Organizational factors of potential importance to service provision were considered: health care region, size of catchment area/population, type of department/municipality and socioeconomic index. RESULTS Response rates for the provision of each core component of cardiac rehabilitation ranged from 64% to 98%. All hospitals and municipalities provided some aspect of cardiac rehabilitation to survivors of cardiac arrest. Across hospitals, provision of four core components of cardiac rehabilitation to survivors of cardiac arrest was lower compared with post acute myocardial infarction patients: patient education (relative risk (RR) = 0.45 (95% confidence interval (CI) 0.27 to 0.75)), exercise training (RR = 0.69 (95% CI 0.49 to 0.98)), screening for anxiety and depression (RR = 0.64 (95% CI 0.46 to 0.90) and nutritional counselling RR = 0.76 (95% CI 0.62 to 0.93)). No difference was found in the provision of core components across municipalities. Overall, the provision of cardiac rehabilitation to survivors of cardiac arrest was not affected by organizational factors. CONCLUSION This study indicates a need for future research to inform the development, adoption and implementation of equal access to all components of cardiac rehabilitation for survivors of cardiac arrest in Denmark.
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Affiliation(s)
- Lars H Tang
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Department of Regional Health Research, University of Southern Denmark, Slagelse, Denmark
| | - Vicky Joshi
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Cecilie Lindström Egholm
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark.,The Danish Clinical Quality Program (RKKP), National Clinical Registries, Aarhus N, Denmark
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19
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Carlesso LC, Skou ST, Tang LH, Simonÿ C, Brooks D. La multimorbidité : l’abandon du modèle de réadaptation axé sur une seule maladie. Physiother Can 2020; 72:4-6. [DOI: 10.3138/ptc-72-1-gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Lisa C. Carlesso
- École des sciences de la réadaptation, université McMaster
- Institut de recherche du St. Joseph’s Hospital, Hamilton (Ontario)
- École de réadaptation, Université de Montréal, Montréal (Québec)
| | - Søren T. Skou
- unité de recherche de la fonction musculosquelettique et de la physiothérapie, département des sciences sportives et de la biomécanique clinique
- département de physiothérapie et d’ergothérapie
| | - Lars H. Tang
- département de physiothérapie et d’ergothérapie
- centre national de réadaptation et de soins palliatifs, université du Danemark du Sud et hôpital universitaire d’Odense, Nyborg, Danemark
| | - Charlotte Simonÿ
- Institut de santé régional, université du Danemark du Sud, Odense
- département de physiothérapie et d’ergothérapie
- département de recherche, hôpitaux Naestved-Slagelse-Ringsted, Région Zélande, Slagelse, Danemark
| | - Dina Brooks
- École des sciences de la réadaptation, université McMaster
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20
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Carlesso LC, Skou ST, Tang LH, Simonÿ C, Brooks D. Multimorbidity: Making the Case for an End to Disease-Specific Rehabilitation. Physiother Can 2020; 72:1-3. [PMID: 34385742 DOI: 10.3138/ptc-72-1-gee] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Lisa C Carlesso
- School of Rehabilitation Science, McMaster University.,Research Institute of St. Joseph's Hospital, Hamilton, Ont.,School of Rehabilitation, Université de Montréal, Montreal, Que
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics.,Department of Physiotherapy and Occupational Therapy
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy.,National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Charlotte Simonÿ
- Department of Physiotherapy and Occupational Therapy.,Institute of Regional Health, University of Southern Denmark, Odense.,Department of Research, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University
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21
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Datta J, Da Silva EM, Kandoth C, Song T, Russo AE, Hernandez JM, Taylor BS, Janjigian YY, Tang LH, Solit DB, Strong VE. Poor survival after resection of early gastric cancer: extremes of survivorship analysis reveal distinct genomic profile. Br J Surg 2019; 107:14-19. [PMID: 31763684 DOI: 10.1002/bjs.11443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 11/06/2022]
Abstract
A subset of patients with early gastric cancer demonstrate early recurrence and poor survival despite margin-negative resection. This study used an extremes-of-survivorship approach to identify an association between TP53 hotspot mutations co-occurring with loss of heterozygosity and unexpectedly poor survival in early gastric cancer. This distinct genomic profile may be a novel biomarker of poor survival in patients with completely resected early gastric cancer, and warrants large-scale validation. Promising, validation needed.
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Affiliation(s)
- J Datta
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - E M Da Silva
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Kandoth
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - T Song
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A E Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J M Hernandez
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Thoracic and Oncologic Surgery Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - B S Taylor
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Y Y Janjigian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - L H Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - V E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
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22
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Dibben GO, Hillsdon M, Dalal HM, Metcalf B, Doherty P, Tang LH, Taylor RS. Correlates of Physical Activity in People With Heart Failure: Multivariable Analysis Based on REACH-HF Randomised Trials. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560870.31533.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Dibben GO, Taylor RS, Dalal HM, Metcalf B, Gandhi MM, Tang LH, Doherty P, Hillsdon M. Measuring Physical Activity in People with Heart Failure - An Accelerometer Calibration Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561846.71078.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Hong W, Hao BW, Peng F, Peng GY, Huang LM, Xu J, Cao WT, Liao BL, Tang LH, Pu JD, Li B, Ran PX. [The mechanism of nicotine on human bronchial smooth muscle cell contraction]. Zhonghua Jie He He Hu Xi Za Zhi 2018; 41:333-339. [PMID: 29747275 DOI: 10.3760/cma.j.issn.1001-0939.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the molecular mechanism of contractility dysfunction of human bronchial smooth muscle cells induced by nicotine. Methods: Primary human bronchial smooth muscle cells were cultured in vitro. The cells were divided into a control group and a nicotine group which was treated with 10(-5) mol/L nicotine for 48 h and transfected with or without α7nAChR-siRNA (The siNC group, siNC + nicotine group and siα7nAChR + nicotine group). The effects of nicotine on the cell contractile function were examined by collagen gel shrinkage assay. The expressions of α7nAChR and TRPC6 protein in nicotine-treated human bronchial smooth muscle cells were detected by Western blotting. The change of intracellular calcium concentration by nicotine was detected by calcium ion imaging system.Data were analyzed by t test or single factor analysis of variance. Results: The area of collagen gel in the nicotine group (24±8)% was significantly lower than that in the control group (59±14)% (t=3.78, P<0.05). Compared with the control group, the expression of α7nAChR protein in nicotine-induced group (173±16)% was significantly higher than that of controls 100±0)%, t=-6.848, P<0.05. Compared with the siNC group [(72±10)%, (0.79±0.07), (0.41±0.04) and (0.17±0.02) respectively], the collagen gel area of siNC + nicotine group was significantly reduced by (37±10)%. However, the basal calcium level (1.04±0.02), store operated calcium entry level (SOCE, 0.68±0.03) and receptor operated calcium entry level (ROCE, 0.36±0.02) were remarkably elevated in the nicotine treated group (all P<0.05). Furthermore, compared with siNC + nicotine group, the area of collagen gel in siα7nAChR + nicotine group was significantly increased (62±10)%, and the basal calcium level (0.78±0.06), SOCE level (0.39±0.05) and ROCE level (0.15±0.02) were significantly reduced (all P<0.05). Conclusions: Nicotine can increase the expression of TRPC6 protein, SOCE and ROCE level, and increase the intracellular calcium concentration by upregulating the expression of α7nAChR protein, thereby promoting smooth muscle cell contraction.
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Affiliation(s)
- W Hong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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25
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Tang LH, Lao QY, Yu L, Wang J. [Spindle cell lipoma and pleomorphic lipoma: a clinicopathologic analysis of 65 cases]. Zhonghua Bing Li Xue Za Zhi 2018; 47:263-268. [PMID: 29690665 DOI: 10.3760/cma.j.issn.0529-5807.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical and pathological features of spindle cell lipoma (SCL) and pleomorphic lipoma (PL) with emphasis on differential diagnosis. Methods: Sixty-five cases of SCL/PL from the archive of Department of Pathology, Fudan University Shanghai Cancer Center, from August of 2006 to June of 2017, were included in the study. Immunohistochemistry by EnVision method, MDM2 gene amplifycation and DDIT3 gene translocation by fluorescence in situ hybridization(FISH) were detected and the literature was reviewed. Results: There were 53 males and 12 females with age ranging from 26 to 82 years (mean, 57 years; median, 59 years). The majority of the lesions occurred in the neck/posterior neck/nuchal region, upper back and shoulder. A small percentage of lesions developed in the extremities, face and trunk, and rarely in the epiglottis, mediastinum, labium majus and perineum. Clinically, the tumor usually manifested as a slowly growing mass or nodule. It was often encapsulated, ranging from 1 to 13 cm (mean, 4.1 cm; median, 3.5 cm) in size. Microscopically, SCL was composed of mature adipose tissue, bland spindle cells and bright eosinophilic "ropey" collagen fibers that varied in proportion. Of 45 SCL, 28 cases (62.2%) were classical, 6 cases (13.3%) were myxoid, 5 cases (11.1%) were fat-poor, 3 cases (6.7%) were fat-free, and 3 cases (6.5%) were pseudoangiomatoid. PL showed similar features as SCL, but was characterized by the presence of scattered floret giant cells. Of 20 PL, 11 cases (55.0%) were classical, 6 cases (30.0%) were mixed SCL/PL, 3 cases (15.0%) were fat-free. Both SCL and PL contained scattered mast cells in the stroma. By immunohistochemistry, the spindle cells in SCL and the floret giant cells in PL showed strong positivity for CD34 (52/52, 100.0%), bcl-2 (24/26, 92.3%) and CD99 (6/6), whereas they were negative for S-100 protein and STAT6. FISH analysis of MDM2 (17 cases) and DDIT3 (4 cases) was negative in all cases. Follow-up information was available in 32 patients (3 to 96 months), with local recurrence in only one patient. Conclusions: SCL and PL belong to the same entity but may exhibit morphological disparities. Of note, the fat-poor and fat-free variants are easily mistaken for other mesenchymal tumors. Attention should be paid in their differential diagnosis.
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Affiliation(s)
- L H Tang
- Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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26
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Tolstrup Larsen R, Tang LH, Brochmann N, Meulengracht Flachs E, Illemann Christensen A, Hasselbalch HC, Zwisler AD. Associations between fatigue, physical activity, and QoL in patients with myeloproliferative neoplasms. Eur J Haematol 2018; 100:550-559. [DOI: 10.1111/ejh.13048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Rasmus Tolstrup Larsen
- REHPA; Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern and Odense University Hospital; Copenhagen Denmark
- CopenRehab; Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Lars H. Tang
- REHPA; Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern and Odense University Hospital; Copenhagen Denmark
| | - Nana Brochmann
- Department of Hematology; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine; Bisbebjerg University Hospital; Copenhagen Denmark
| | | | - Hans C. Hasselbalch
- Department of Hematology; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
| | - Ann-Dorthe Zwisler
- REHPA; Danish Knowledge Centre for Rehabilitation and Palliative Care; University of Southern and Odense University Hospital; Copenhagen Denmark
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27
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Liu X, Hu YC, Tang LH. [Research progress of Rosai-Dorfman disease]. Zhonghua Bing Li Xue Za Zhi 2017; 46:443-446. [PMID: 28592003 DOI: 10.3760/cma.j.issn.0529-5807.2017.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Xie X, Tang LH, Huang XX, Wu Y, Su HL. [Latent tuberculosis infection and associated risk factors among the tuberculosis contacts in one of district in Shanghai]. Zhonghua Jie He He Hu Xi Za Zhi 2016; 39:944-947. [PMID: 27938545 DOI: 10.3760/cma.j.issn.1001-0939.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the prevalence of latent tuberculosis infection(LTBI) and associated risk factors among the tuberculosis(TB) contacts in Minhang District of Shanghai. Methods: A self-designed questionnaire was used to acquire socio-demographic information and to assess the degree of exposure to index cases. LTBI screening was performed by T-SPOT.TB assay. Pearson chi-square test and Logistic regression analyses were used to identify the risk factors associated with LTBI among the TB contacts. Results: A total of 137 contacts from 59 mycobacterial (culture) positive pulmonary TB patients were enrolled in this study. In these contacts, there were 54 men and 83 women, with the average age of 42. LTBI was identified in 20% (27/137) of these contacts. Several risk factors were found by logistic analyses in this study. The worse the ventilation in the exposure location was, the more likely to develop LTBI. Contacts aged more than 60 (42.1%) were 3.9 times more likely to develop LTBI than those aged less than 60 (16.1%). Individuals in contact with TB patients for more than 40 h/week(25.8%) had a 4.2 times risk of LTBI as compared to those for less than 40 h/week(6.8%). Conclusion: The prevalence of LTBI was 20% among the TB contacts in this study, highlighting the need of TB screening and intervention among TB contacts.
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Affiliation(s)
- X Xie
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
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29
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Wu J, Tang LH, Yang CG, Yan HQ, Sun H, Shen X. [Application of whole genome sequencing technology in the epidemiology of tuberculosis]. Zhonghua Liu Xing Bing Xue Za Zhi 2016; 37:1644-1646. [PMID: 27998414 DOI: 10.3760/cma.j.issn.0254-6450.2016.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To delineate the application of whole genome sequencing technology in the epidemiology of tuberculosis. Methods: From 2009 to 2012, nine Mycobacterium tuberculosis that sharing identical variable number of tandem repeats genotype (VNTR) patterns were reported from two TB cases designated hospitals. Both whole-genome sequencing analysis (WGS) and epidemiologic investigations were performed to describe the transmission patterns of these Mycobacterium tuberculosis. Results: By WGS analysis, two genomic clusters including 7 and 2 Mycobacterium tuberculosis were noticed, respectively. The cluster of 2 cases possessed more than 15 single nucleotide polymorphisms (SNPs) when compared to the cluster of 7 cases and suggesting that the transmission route was independent. The transmission chain based on the SNPs difference showed the process of the propagation direction and the accumulation of drug resistance mutations in each cluster. Conclusion: Using a WGS-based genomic epidemiologic approach, we were able to reconstruct the tuberculosis transmission network, tracing the putative source of the transmission and determining the transmission direction or the missing links.
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Affiliation(s)
- J Wu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 100336, China
| | - L H Tang
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - C G Yang
- Fudan University, Shanghai 200032, China
| | - H Q Yan
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - H Sun
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - X Shen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 100336, China
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30
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Goh CK, Valavan SE, Low TK, Tang LH. Effects of different surface modification and contents on municipal solid waste incineration fly ash/epoxy composites. Waste Manag 2016; 58:309-315. [PMID: 27267794 DOI: 10.1016/j.wasman.2016.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/09/2016] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
Incineration fly ash, a waste from municipal solid waste incineration plant can be used to replace conventional filler as reinforcing filler to enhance the mechanical strength of a composite. Surface modification was performed on the incineration fly ash before mixing into the soft polymer matrix so as to improve interfacial bond of the filler and epoxy resin. In this study, detailed characterisation of mechanical, morphological and leaching behaviours of municipal solid waste incineration (MSWI) fly ash infused composite has been carried out. Flexural and tensile test was conducted to determine the effect on mechanical properties of the composite by varying the concentration of incineration fly ash filler added into polymer matrix and surface modification of incineration fly ash filler using silane coupling agent and colloidal mesoporous silica (CMS). The results indicated that composite infused with incineration fly ash filler surface treated with CMS shown improvement on the tensile and flexural strengths. In addition, SEM images showed that surface modification of incineration fly ash with colloidal mesoporous silica enhanced the interfacial bonding with polymer resin which explained the improvement of mechanical strength. Leaching test showed result of toxic metals such as Pb, Zn, Fe, Cu, Cr, Cd and Rb immobilised in the polymer matrix of the composite. Hence, the use of MSWI fly ash as reinforcing filler in the composite appears green and sustainable because this approach is a promising opportunity to substitute valuable raw material with MSWI fly ash.
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Affiliation(s)
- C K Goh
- Republic Polytechnic, 9 Woodlands Ave 9, Singapore 738964, Singapore.
| | - S E Valavan
- Republic Polytechnic, 9 Woodlands Ave 9, Singapore 738964, Singapore
| | - T K Low
- Republic Polytechnic, 9 Woodlands Ave 9, Singapore 738964, Singapore
| | - L H Tang
- Republic Polytechnic, 9 Woodlands Ave 9, Singapore 738964, Singapore
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31
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Zwisler AD, Norton RJ, Dean SG, Dalal H, Tang LH, Wingham J, Taylor RS. Home-based cardiac rehabilitation for people with heart failure: A systematic review and meta-analysis. Int J Cardiol 2016; 221:963-9. [PMID: 27441476 DOI: 10.1016/j.ijcard.2016.06.207] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/23/2016] [Accepted: 06/25/2016] [Indexed: 12/19/2022]
Abstract
AIMS To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs. METHODS Randomised controlled trials were initially identified from previous systematic reviews of CR. We undertook updated literature searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Library to December 2015. A total of 19 trials with median follow up of 3months were included - 17 comparisons of home-based CR to usual care (995 patients) and four comparing home and centre-based CR (295 patients). RESULTS Compared to usual care, home-based CR improved VO2max (mean difference: 1.6ml/kg/min, 0.8 to 2.4) and total Minnesota Living with Quality of Life score (-3.3, -7.5 to 1.0), with no difference in mortality, hospitalisation or study drop out. Outcomes and costs were similar between home-based and centre-based CR with the exception of higher levels of trial completion in the home-based group (relative risk: 1.2, 1.0 to 1.3). CONCLUSIONS Home-based CR results in short-term improvements in exercise capacity and health-related quality of life of heart failure patients compared to usual care. The magnitude of outcome improvement is similar to centre-based CR. Home-based CR appears to be safe with no evidence of increased risk of hospitalisation or death. These findings support the provision of home-based CR for heart failure as an evidence-based alternative to the traditional centre-based model of provision.
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Affiliation(s)
- Ann-Dorthe Zwisler
- Danish Centre of Rehabilitation and Palliative Care, University Hospital Odense, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Rebecca J Norton
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, UK
| | - Sarah G Dean
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Hayes Dalal
- Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK; Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Lars H Tang
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Jenny Wingham
- Research, Development and Innovation, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK; Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
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Sibilitz KL, Berg SK, Tang LH, Risom SS, Gluud C, Lindschou J, Kober L, Hassager C, Taylor RS, Zwisler AD. Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database Syst Rev 2016; 3:CD010876. [PMID: 26998683 DOI: 10.1002/14651858.cd010876.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation may benefit heart valve surgery patients. We conducted a systematic review to assess the evidence for the use of exercise-based intervention programmes following heart valve surgery. OBJECTIVES To assess the benefits and harms of exercise-based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following heart valve surgery. We considered programmes including exercise training with or without another intervention (such as a psycho-educational component). SEARCH METHODS We searched: the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS (Bireme); and Conference Proceedings Citation Index-S (CPCI-S) on Web of Science (Thomson Reuters) on 23 March 2015. We handsearched Web of Science, bibliographies of systematic reviews and trial registers (ClinicalTrials.gov, Controlled-trials.com, and The World Health Organization International Clinical Trials Registry Platform). SELECTION CRITERIA We included randomised clinical trials that investigated exercise-based interventions compared with no exercise intervention control. The trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and received either heart valve replacement, or heart valve repair. DATA COLLECTION AND ANALYSIS Two authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluation of bias risk domains. Clinical and statistical heterogeneity were assessed. Meta-analyses were undertaken using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence. We sought to assess the risk of random errors with trial sequential analysis. MAIN RESULTS We included two trials from 1987 and 2004 with a total 148 participants who have had heart valve surgery. Both trials had a high risk of bias.There was insufficient evidence at 3 to 6 months follow-up to judge the effect of exercise-based cardiac rehabilitation compared to no exercise on mortality (RR 4.46 (95% confidence interval (CI) 0.22 to 90.78); participants = 104; studies = 1; quality of evidence: very low) and on serious adverse events (RR 1.15 (95% CI 0.37 to 3.62); participants = 148; studies = 2; quality of evidence: very low). Included trials did not report on health-related quality of life (HRQoL), and the secondary outcomes of New York Heart Association class, left ventricular ejection fraction and cost. We did find that, compared with control (no exercise), exercise-based rehabilitation may increase exercise capacity (SMD -0.47, 95% CI -0.81 to -0.13; participants = 140; studies = 2, quality of evidence: moderate). There was insufficient evidence at 12 months follow-up for the return to work outcome (RR 0.55 (95% CI 0.19 to 1.56); participants = 44; studies = 1; quality of evidence: low). Due to limited information, trial sequential analysis could not be performed as planned. AUTHORS' CONCLUSIONS Our findings suggest that exercise-based rehabilitation for adults after heart valve surgery, compared with no exercise, may improve exercise capacity. Due to a lack of evidence, we cannot evaluate the impact on other outcomes. Further high-quality randomised clinical trials are needed in order to assess the impact of exercise-based rehabilitation on patient-relevant outcomes, including mortality and quality of life.
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Affiliation(s)
- Kirstine L Sibilitz
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, 2100
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Sun P, Su N, Lin FZ, Ma L, Wang HJ, Rong X, Dai YD, Li J, Jian ZW, Tang LH, Xiao W, Li CQ. Prevalence of hepatitis A viral RNA and antibodies among Chinese blood donors. Genet Mol Res 2015; 14:16431-7. [PMID: 26662440 DOI: 10.4238/2015.december.9.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Like other developing countries, China was reported to have a relatively high seroprevalence of anti-hepatitis A antibodies (anti-HAV). However, no studies have evaluated the prevalence of anti-HAV and HAV RNA among voluntary blood donors with or without elevated serum alanine transaminase (ALT) levels. Anti-HAV antibodies were detected using an enzyme-linked immunosorbent assay, and reverse transcription quantitative polymerase chain reaction was carried out for detection of HAV RNA. In the current study, we analyzed a total of 450 serum samples with elevated ALT levels (≥40 U/L) and 278 serum samples with non-elevated ALT levels. Seroprevalence rates of anti-HAV were 51.6% in donors with elevated ALT and 41.4% in donors with non-elevated ALT; however, none of the samples was positive for HAV RNA. The results of our study showed lower seroprevalence rates of anti-HAV in blood donors (irrespective of ALT levels) than those in published data on Chinese populations. Although donors with elevated ALT had statistically higher prevalence rates of anti- HAV than did those with non-elevated ALT, none of the serum samples had detectable levels of the active virus. In conclusion, our results demonstrate that the transmission of hepatitis A by blood transfusion will occur rarely.
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Affiliation(s)
- P Sun
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - N Su
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - F Z Lin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - L Ma
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - H J Wang
- Blood Center of the Beijing Red Cross, Beijing, China
| | - X Rong
- Guangzhou Blood Center, Guangzhou, China
| | - Y D Dai
- Blood Center of the Nanjing Red Cross, Nanjing, China
| | - J Li
- Shaanxi Blood Center, Xian, China
| | - Z W Jian
- Deyang Center Blood Station, Deyang, China
| | - L H Tang
- Suzhou Center Blood Station, Suzhou, China
| | - W Xiao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - C Q Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
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Tang LH, Zwisler AD, Taylor RS, Doherty P, Zangger G, Berg SK, Langberg H. Self-rating level of perceived exertion for guiding exercise intensity during a 12-week cardiac rehabilitation programme and the influence of heart rate reducing medication. J Sci Med Sport 2015; 19:611-5. [PMID: 26410665 DOI: 10.1016/j.jsams.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/17/2015] [Accepted: 08/25/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To investigate whether self-rating level of perceived exertion can adequately guide exercise intensity during a 12-week cardiac rehabilitation programme. DESIGN Linear regression analysis using rehabilitation data from two randomised controlled trials. METHODS Patients undergoing radiofrequency ablation for atrial fibrillation or following heart valve surgery and participating in exercise-based rehabilitation were included. The 12-week rehabilitation outpatient programme comprised three weekly training sessions, each consisting of 20min aerobic exercise divided into three steps. Patients were asked to base their exercise intensity for each step on a predefined rating of perceived exertion specified in a training diary. Exercise intensity was objectively measured by heart rate during the last 2min for each exercise step. Comparative analysis and linear regression of the rating of perceived exertion and heart rate were performed. RESULTS A total of 2622 ratings of perceived exertion were collected from 874 training sessions in 97 patients. Heart rate and rating of perceived exertion were associated both across all three exercise steps and individually for each step, with a mean of 6 to7bpm per 1-point difference in the rating of perceived exertion (p<0.001). Adjusting for rate-reducing medication slightly improved the strength of the association. CONCLUSIONS The association between change in the rating of perceived exertion and change in heart rate indicates that a diary-led and self-regulated model using rating of perceived exertion can help guide exercise intensity in everyday clinical practice among patients with heart disease, irrespective if they are taking heart rate-reducing medication.
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Affiliation(s)
- Lars H Tang
- Department of Cardiology, The Heart Centre, Rigshospitalet Copenhagen University Hospital, Denmark; CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; Bachelor's Degree Programme in Physiotherapy, Department of Rehabilitation and Nutrition, Faculty of Health and Technology, Metropolitan University College, Denmark; The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Denmark.
| | - Ann-Dorthe Zwisler
- Department of Cardiology, The Heart Centre, Rigshospitalet Copenhagen University Hospital, Denmark; National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Denmark
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, United Kingdom; National Institute of Public Health, University of Southern Denmark, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, United Kingdom
| | - Graziella Zangger
- Department of Cardiology, The Heart Centre, Rigshospitalet Copenhagen University Hospital, Denmark
| | - Selina K Berg
- Department of Cardiology, The Heart Centre, Rigshospitalet Copenhagen University Hospital, Denmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
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Uddin J, Zwisler AD, Lewinter C, Moniruzzaman M, Lund K, Tang LH, Taylor RS. Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: A meta-regression analysis. Eur J Prev Cardiol 2015; 23:683-93. [PMID: 26330205 DOI: 10.1177/2047487315604311] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/14/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to undertake a comprehensive assessment of the patient, intervention and trial-level factors that may predict exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure. DESIGN Meta-analysis and meta-regression analysis. METHODS Randomized controlled trials of exercise-based rehabilitation were identified from three published systematic reviews. Exercise capacity was pooled across trials using random effects meta-analysis, and meta-regression used to examine the association between exercise capacity and a range of patient (e.g. age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias) factors. RESULTS 55 trials (61 exercise-control comparisons, 7553 patients) were included. Following exercise-based rehabilitation compared to control, overall exercise capacity was on average 0.95 (95% CI: 0.76-1.41) standard deviation units higher, and in trials reporting maximum oxygen uptake (VO2max) was 3.3 ml/kg.min(-1) (95% CI: 2.6-4.0) higher. There was evidence of a high level of statistical heterogeneity across trials (I(2) statistic > 50%). In multivariable meta-regression analysis, only exercise intervention intensity was found to be significantly associated with VO2max (P = 0.04); those trials with the highest average exercise intensity had the largest mean post-rehabilitation VO2max compared to control. CONCLUSIONS We found considerable heterogeneity across randomized controlled trials in the magnitude of improvement in exercise capacity following exercise-based rehabilitation compared to control among patients with coronary heart disease or heart failure. Whilst higher exercise intensities were associated with a greater level of post-rehabilitation exercise capacity, there was no strong evidence to support other intervention, patient or trial factors to be predictive.
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Affiliation(s)
- Jamal Uddin
- Department of Cardiac Surgery, Ibrahim Cardiac Hospital & Research Institute, Bangladesh National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ann-Dorthe Zwisler
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Mohammad Moniruzzaman
- Non-communicable Disease Unit, World Health Organization (WHO), Country office for Bangladesh, Dhaka, Bangladesh
| | - Ken Lund
- Department of Physiotherapy and Occupational Therapy, Holbaek Hospital, Denmark
| | - Lars H Tang
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark Bachelor's Degree Programme in Physiotherapy, Dept. of Rehabilitation and Nutrition, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Denmark Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Li XH, Wu JS, Tang LH, Hu D. Identification of conserved microRNAs and their target genes in Nile tilapia (Oreochromis niloticus) by bioinformatic analysis. Genet Mol Res 2015; 14:2785-92. [PMID: 25867427 DOI: 10.4238/2015.march.31.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
MicroRNAs (miRNAs) are a class of non-coding RNAs that play important roles in posttranscriptional regulation of target genes. miRNAs are involved in multiple biological processes by degrading targeted mRNAs or repressing mRNA translation in various organisms. Their conserved nature in various organisms makes them a good source of new miRNA discovery using comparative genomic approaches. In the present study, conserved Nile tilapia (Oreochromis niloticus) miRNAs were identified using a bioinformatic strategy based on expressed sequence tag and genome survey sequence databases. A total of 21 new miRNAs were detected and were found to belong to 17 families. Using mature miRNA sequences as queries, potential targets for tilapia miRNAs were predicted using a local BLAST program and the miRanda software. Target proteins identified using miRanda and BLAST analyses included transcription factors and molecules important in metabolism, transportation, immunity, stress-related activity, growth, and development. These miRNAs and their targets in tilapia may increase the understanding of the role of miRNAs in regulating the growth and development of tilapia.
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Affiliation(s)
- X H Li
- School of Geography and Biological Information, Nanjing University of Posts and Telecommunications, Nanjing, Jiangsu, China
| | - J S Wu
- School of Geography and Biological Information, Nanjing University of Posts and Telecommunications, Nanjing, Jiangsu, China
| | - L H Tang
- School of Geography and Biological Information, Nanjing University of Posts and Telecommunications, Nanjing, Jiangsu, China
| | - D Hu
- School of Geography and Biological Information, Nanjing University of Posts and Telecommunications, Nanjing, Jiangsu, China
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Xia WS, Peng YN, Tang LH, Jiang LS, Yu LN, Zhou XL, Zhang FJ, Yan M. Spinal ephrinB/EphB signalling contributed to remifentanil-induced hyperalgesia via NMDA receptor. Eur J Pain 2014; 18:1231-9. [PMID: 24737575 PMCID: PMC4232047 DOI: 10.1002/j.1532-2149.2014.00478.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/24/2022]
Abstract
Background One of the major unresolved issues in treating pain is the paradoxical hyperalgesia produced by opiates, and accumulating evidence implicate that EphBs receptors and ephrinBs ligands are involved in mediation of spinal nociceptive information and central sensitization, but the manner in which ephrinB/EphB signalling acts on spinal nociceptive information networks to produce hyperalgesia remains enigmatic. The objective of this research was to investigate the role of ephrinB/EphB signalling in remifentanil-induced hyperalgesia (RIH) and its downstream effector. Methods We characterized the remifentanil-induced pain behaviours by evaluating thermal hyperalgesia and mechanical allodynia in a rat hind paw incisional model. Protein expression of EphB1 receptor and ephrinB1 ligand in spinal dorsal horn cord was determined by Western blotting, and Fos was determined by immunohistochemistry assay, respectively. To figure out the manner in which ephrinB/EphB signalling acts with N-methyl-d-aspartic acid (NMDA) receptor, we used MK-801, an antagonist of NMDA receptor, trying to suppressed the hyperalgesia induced by ephrinB1-Fc, an agonist of ephrinB/EphB. Results Continuing infusion of remifentanil produced a thermal hyperalgesia and mechanical allodynia, which was accompanied with increased protein expression of spinal-level EphB1 receptor, ephrinB1 ligand and Fos; what appeared above was suppressed by pretreatment with EphB1-Fc, an antagonist of ephrinB/EphB or MK-801, and increased pain behaviours induced by intrathecal injection of ephrinB1-Fc, an agonist of ephrinB/EphB, were suppressed by MK-801. Conclusions Our findings indicated that ephrinB/EphB signalling is involved in RIH. EphrinB/EphB signalling might be the upstream of NMDA receptor. What's already known about this topic? What does this study add?
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Affiliation(s)
- W S Xia
- Department of Anesthesiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Sibilitz KL, Berg SK, Tang LH, Risom SS, Gluud C, Lindschou J, Kober L, Hassager C, Taylor RS, Zwisler AD. Exercise-based cardiac rehabilitation for adults after heart valve surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010876] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lee KS, Tang LH, Shia J, Paty PB, Weiser MR, Guillem JG, Temple LK, Nash GM, Reidy D, Saltz L, Gollub MJ. Goblet cell carcinoid neoplasm of the appendix: clinical and CT features. Eur J Radiol 2012; 82:85-9. [PMID: 23088880 DOI: 10.1016/j.ejrad.2012.05.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/29/2012] [Accepted: 05/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the clinical and CT imaging features of goblet cell carcinoid (GCC) neoplasm of the appendix. METHODS AND MATERIALS A computer search of pathology and radiology records over a 19-year period at our two institutions was performed using the search string "goblet". In the patients with appendiceal GCC neoplasms who had abdominopelvic CT, imaging findings were categorized, blinded to gross and surgical description, as: "Appendicitis", "Prominent appendix without peri-appendiceal infiltration", "Mass" or "Normal appendix". The CT appearance was correlated with an accepted pathological classification of: low grade GCC, signet ring cell adenocarcinoma ex, and poorly differentiated adenocarcinoma ex GCC group. RESULTS Twenty-seven patients (age range, 28-80 years; mean age, 52 years; 15 female, 12 male) with pathology-proven appendiceal GCC neoplasm had CT scans that were reviewed. Patients presented with acute appendicitis (n=12), abdominal pain not typical for appendicitis (n=14) and incidental finding (n=1). CT imaging showed 9 Appendicitis, 9 Prominent appendices without peri-appendiceal infiltration, 7 Masses and 2 Normal appendices. Appendicitis (8/9) usually correlated with typical low grade GCC on pathology. In contrast, the majority of Masses and Prominent Appendices without peri-appendiceal infiltration were pathologically confirmed to be signet ring cell adenocarcinoma ex GCC. Poorly differentiated adenocarcinoma ex GCC was seen in only a small minority of patients. Hyperattenuation of the appendiceal neoplasm was seen in a majority of cases. CONCLUSIONS GCC neoplasm of the appendix should be considered in the differential diagnosis in patients with primary appendiceal malignancy. Our cases demonstrated close correlation between our predefined CT pattern and the pathological classification.
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Affiliation(s)
- K S Lee
- Department of Radiology Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
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Janjigian YY, Werner D, Pauligk C, Steinmetz K, Kelsen DP, Jäger E, Altmannsberger HM, Robinson E, Tafe LJ, Tang LH, Shah MA, Al-Batran SE. Prognosis of metastatic gastric and gastroesophageal junction cancer by HER2 status: a European and USA International collaborative analysis. Ann Oncol 2012; 23:2656-2662. [PMID: 22689179 DOI: 10.1093/annonc/mds104] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Y Y Janjigian
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College of Cornell University, New York, USA
| | - D Werner
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | - C Pauligk
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | - K Steinmetz
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | - D P Kelsen
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College of Cornell University, New York, USA
| | - E Jäger
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | | | - E Robinson
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - L J Tafe
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York
| | - L H Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York
| | - M A Shah
- Department of Medicine, Weill Cornell Medical College of Cornell University, New York, USA
| | - S-E Al-Batran
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt.
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Janjigian YY, Werner D, Pauligk C, Steinmetz K, Kelsen DP, Jäger E, Altmannsberger HM, Robinson E, Tafe LJ, Tang LH, Shah MA, Al-Batran SE. Prognosis of metastatic gastric and gastroesophageal junction cancer by HER2 status: a European and USA International collaborative analysis. Ann Oncol 2012. [PMID: 22689179 DOI: 10.1093/annonc/mds104.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To determine whether human epidermal growth factor receptor 2 (HER2) status is an independent prognostic factor in metastatic gastric and gastroesophageal junction (GEJ) adenocarcinoma. PATIENTS AND METHODS Formalin-fixed paraffin-embedded tumor samples from 381 metastatic gastric/GEJ cancer patients enrolled at Krankenhaus Nordwest and Memorial Sloan-Kettering Cancer Centers on six first-line trials of chemotherapy without trastuzumab were examined for HER2 by immunohistochemistry (IHC) and in situ hybridization (ISH). IHC 3+ or ISH-positive tumors were considered HER2 positive. RESULTS Seventy-eight of 381 patients (20%) had HER2-positive disease. In the multivariate logistic model, there were significantly higher rates of HER2 positivity in patients with liver metastasis (liver metastasis 31%; no liver metastasis 11%; P = 0.025) and intestinal histology (intestinal 33%; diffuse/mixed 8%; P = 0.001). No significant differences in HER2 positivity were found between resections and biopsies or primaries and metastases. Patients with HER2-positive gastric cancer had longer median overall survival compared with HER2-negative gastric cancer patients (13.9 versus 11.4 months, P = 0.047), but multivariate analysis indicated that HER2 status was not an independent prognostic factor (hazard ratio 0.79; 0.44-1.14; P = 0.194). CONCLUSIONS Approximately 20% of Western patients with metastatic gastric cancer are HER2 positive. Unlike breast cancer, HER2 positivity is not independently prognostic of patient outcome in metastatic gastric or GEJ.
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Affiliation(s)
- Y Y Janjigian
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College of Cornell University, New York, USA
| | - D Werner
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | - C Pauligk
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | - K Steinmetz
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | - D P Kelsen
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College of Cornell University, New York, USA
| | - E Jäger
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt
| | | | - E Robinson
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - L J Tafe
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York
| | - L H Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York
| | - M A Shah
- Department of Medicine, Weill Cornell Medical College of Cornell University, New York, USA
| | - S-E Al-Batran
- Department of Hematology and Oncology, Institute of Clinical Research, Krankenhaus Nordwest, University Cancer Center, Frankfurt.
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Winder T, Wilson PM, Yang D, Zhang W, Ning Y, Power DG, Bohanes P, Gerger A, Tang LH, Shah M, Lenz HJ. An individual coding polymorphism and the haplotype of the SPARC gene predict gastric cancer recurrence. Pharmacogenomics J 2012; 13:342-8. [PMID: 22491017 DOI: 10.1038/tpj.2012.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/14/2012] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
The 5-year survival rate for gastric adenocarcinoma (GA) remains only 40% and biomarkers to identify patients at high risk of tumor recurrence are urgently needed. Secreted protein acidic and rich in cysteine (SPARC) is an extracellular matrix glycoprotein that mediates cell matrix interactions, and upregulation of SPARC can promote tumor progression and metastasis. This study investigated whether single-nucleotide polymorphisms (SNPs) in SPARC impact the prognosis of GA. Blood or formalin-fixed, paraffin-embedded tissues were obtained from 137 GA patients at the University of Southern California and Memorial Sloan-Kettering Cancer Center medical facilities. DNA was isolated and five SNPs in the SPARC 3'-untranslated region (UTR) were evaluated by DNA sequencing or PCR-restriction fragment length polymorphism. Associations between SNPs and time to tumor recurrence (TTR) were analyzed using Kaplan-Meier curves, log-rank tests, and likelihood-ratio test within logistic or Cox regression model as appropriate. Patients carrying at least one G allele of the SPARC rs1059829 polymorphism (GG, AG) showed a median TTR of 3.7 years compared with 2.1 years TTR for patients with AA (hazard ratio (HR) 0.57; P=0.033). In a multivariate analysis adjusted for T and N category as covariates and stratified by race, hospital and chemotherapy, patients with at least one SPARC rs1059829 G allele (GG, AG) remained significantly associated with superior TTR than patients with AA genotype (adjusted P=0.026). In addition, patients harboring the G-A-A haplotype had the highest risk of tumor recurrence (HR 1.892; adjusted P=0.016). Our findings suggest that SPARC 3'-UTR SNPs may be useful in predicting GA patients at increased risk of recurrence.
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Affiliation(s)
- T Winder
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Winder T, Wilson PM, Yang D, Zhang W, Ning Y, Power DG, Bohanes P, Gerger A, Tang LH, Shah M, Lenz HJ. An individual coding polymorphism and the haplotype of the SPARC gene predict gastric cancer recurrence. Pharmacogenomics J 2012. [PMID: 22491017 DOI: 10.1038/tpj.2012.11.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 5-year survival rate for gastric adenocarcinoma (GA) remains only 40% and biomarkers to identify patients at high risk of tumor recurrence are urgently needed. Secreted protein acidic and rich in cysteine (SPARC) is an extracellular matrix glycoprotein that mediates cell matrix interactions, and upregulation of SPARC can promote tumor progression and metastasis. This study investigated whether single-nucleotide polymorphisms (SNPs) in SPARC impact the prognosis of GA. Blood or formalin-fixed, paraffin-embedded tissues were obtained from 137 GA patients at the University of Southern California and Memorial Sloan-Kettering Cancer Center medical facilities. DNA was isolated and five SNPs in the SPARC 3'-untranslated region (UTR) were evaluated by DNA sequencing or PCR-restriction fragment length polymorphism. Associations between SNPs and time to tumor recurrence (TTR) were analyzed using Kaplan-Meier curves, log-rank tests, and likelihood-ratio test within logistic or Cox regression model as appropriate. Patients carrying at least one G allele of the SPARC rs1059829 polymorphism (GG, AG) showed a median TTR of 3.7 years compared with 2.1 years TTR for patients with AA (hazard ratio (HR) 0.57; P=0.033). In a multivariate analysis adjusted for T and N category as covariates and stratified by race, hospital and chemotherapy, patients with at least one SPARC rs1059829 G allele (GG, AG) remained significantly associated with superior TTR than patients with AA genotype (adjusted P=0.026). In addition, patients harboring the G-A-A haplotype had the highest risk of tumor recurrence (HR 1.892; adjusted P=0.016). Our findings suggest that SPARC 3'-UTR SNPs may be useful in predicting GA patients at increased risk of recurrence.
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Affiliation(s)
- T Winder
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
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Dikken JL, van Grieken NCT, Krijnen P, Gönen M, Tang LH, Cats A, Verheij M, Brennan MF, van de Velde CJH, Coit DG. Preoperative chemotherapy does not influence the number of evaluable lymph nodes in resected gastric cancer. Eur J Surg Oncol 2012; 38:319-25. [PMID: 22261085 DOI: 10.1016/j.ejso.2011.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/19/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND While it is suggested that more than 15 lymph nodes (LNs) should be evaluated for accurate staging of gastric cancer, LN yield in western countries is generally low. The effect of preoperative chemotherapy on LN yield in gastric cancer is unknown. The aim of the present study is to determine whether preoperative chemotherapy is associated with any difference in the number of LNs obtained from specimens of patients who underwent curative surgery for gastric adenocarcinoma. PATIENTS AND METHODS In 1205 patients from Memorial Sloan-Kettering Cancer Center (MSKCC) and 1220 patients from the Netherlands Cancer Registry (NCR) who underwent a gastrectomy with curative intent for gastric adenocarcinoma without receiving preoperative radiotherapy, LN yield was analyzed, comparing patients who received preoperative chemotherapy and patients who received no preoperative therapy. RESULTS Of the 2425 patients who underwent a gastrectomy, 14% received preoperative chemotherapy. Median LN yields were 23 at MSKCC and 10 in the NCR. Despite this twofold difference in LN yield between the two populations, with multivariate Poisson regression, chemotherapy was not associated with LN yield of either population. Variables associated with increased LN yield were institution, female sex, lower age, total (versus distal) gastrectomy and increasing T-stage. CONCLUSIONS In this patient series, treatment at MSKCC, female sex, lower age, total gastrectomy and increasing primary tumor stage were associated with a higher number of evaluated LNs. Preoperative chemotherapy was not associated with a decrease in LN yield. Evaluating more than 15 LNs after gastrectomy is feasible, with or without preoperative chemotherapy.
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Affiliation(s)
- J L Dikken
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
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Winder T, Bohanes P, Zhang W, Yang D, Power DG, Ning Y, Gerger A, Wilson PM, Tang LH, Shah M, Lee AS, Lenz HJ. GRP78 promoter polymorphism rs391957 as potential predictor for clinical outcome in gastric and colorectal cancer patients. Ann Oncol 2011; 22:2431-2439. [PMID: 21382870 DOI: 10.1093/annonc/mdq771] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Recently, the analysis of gastric and colorectal tumor specimens determined that 78-kiloDalton glucose-regulated protein (GRP78), an endoplasmic reticulum chaperone, up-regulation serves as an efficient mechanism protecting cells against apoptosis and can confer drug resistance. We tested whether functional polymorphisms within the GRP78 gene are related to clinical outcome in gastric and colorectal cancer (CRC) patients. PATIENTS AND METHODS Blood samples of 234 stage II/III CRC patients at the University of Southern California (USC) and formalin-fixed paraffin-embedded tissues of 137 patients with localized gastric adenocarcinoma (GA) at USC and Memorial Sloan-Kettering Cancer Centers were obtained. GRP78 polymorphisms analyzed on germline DNA were correlated with clinical outcome using univariate and multivariate analyses. RESULTS GA patients with the combined GRP78 rs391957 C/T and T/T genotype were at higher risk for tumor recurrence and death [hazard ratio (HR) 2.61; P < 0.001 and HR 3.17; P < 0.001, respectively], than those with C/C. These findings were subsequently tested in a CRC cohort where patients with the homozygous T/T genotype were at highest risk for tumor recurrence (HR 2.61; P = 0.015). The results remained significant after adjusting for clinicopathologic determinants. CONCLUSION These data provide the first evidence that the GRP78 rs391957 polymorphism can predict clinical outcome in localized GA and locally advanced CRC patients.
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Affiliation(s)
- T Winder
- Department of Internal Medicine, Division of Medical Oncology
| | - P Bohanes
- Department of Internal Medicine, Division of Medical Oncology
| | - W Zhang
- Department of Internal Medicine, Division of Medical Oncology
| | - D Yang
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles
| | - D G Power
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, Cornell University, New York
| | - Y Ning
- Department of Internal Medicine, Division of Medical Oncology
| | - A Gerger
- Department of Internal Medicine, Division of Medical Oncology
| | - P M Wilson
- Department of Pathology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles
| | - L H Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, Cornell University, New York
| | - M Shah
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, Cornell University, New York
| | - A S Lee
- Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, USA
| | - H-J Lenz
- Department of Internal Medicine, Division of Medical Oncology; Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles.
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Lurje G, Husain H, Power DG, Yang D, Groshen S, Pohl A, Zhang W, Ning Y, Manegold PC, El-Khoueiry A, Iqbal S, Tang LH, Shah MA, Lenz HJ. Genetic variations in angiogenesis pathway genes associated with clinical outcome in localized gastric adenocarcinoma. Ann Oncol 2009; 21:78-86. [PMID: 19622587 DOI: 10.1093/annonc/mdp280] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Angiogenesis has been attributed to be a well-recognized aspect of human cancer biology. As such, proteinase-activated receptor (PAR)-1, endostatin (ES) and interleukin-8 (IL-8) mediate the regulation of early-onset angiogenesis and in turn impact the process of tumor-growth and disease progression. PATIENTS AND METHODS Formalin-fixed paraffin-embedded tissues were obtained from 137 patients with localized gastric cancer at University of Southern California and Memorial Sloan-Kettering Cancer Center medical facilities. DNA was extracted and genotyping was carried out using PCR-restriction fragment length polymorphism-based protocols. RESULTS In false discovery rate-adjusted univariate analysis, PAR-1 -506 ins/del (P < 0.001), ES +4349 G>A (P = 0.004), and IL-8 -251 T>A (P < 0.0001) were associated with time to tumor recurrence (TTR). Further, PAR-1 -506 ins/del and IL-8 -251 were associated with overall survival (OS). After adjusting for covariates, IL-8 remained significantly associated with TTR (adjusted P = 0.003) and OS (adjusted P = 0.049), whereas ES was significantly associated with TTR (adjusted P = 0.026). CONCLUSIONS Polymorphisms in PAR-1, ES, and IL-8 may serve as independent molecular prognostic markers in patients with localized gastric adenocarcinoma. The assessment of the patients' individual risk on the basis of interindividual genotypes may therefore help to identify patient subgroups at high risk for poor clinical outcome.
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Affiliation(s)
- G Lurje
- Division of Medical Oncology, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Ma X, Tang LH, Qu LB, Ma J, Chen L. Identification of 17 novel major histocompatibility complex-A alleles in a population of Chinese-origin rhesus macaques. ACTA ACUST UNITED AC 2009; 73:184-7. [PMID: 19140828 DOI: 10.1111/j.1399-0039.2008.01168.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Rhesus macaques (Macaca mulatta) serve as important animal models for human disease and vaccine research. Although Chinese rhesus macaques are the same species as those of Indian origin, they are from a geographically separated population and possess divergent major histocompatibility complex (MHC) class I A alleles. In an analysis of 65 Chinese rhesus macaques, 17 novel Mamu-A alleles were identified and deposited under the following accession numbers: EU252155-158, EU262737-741, EU418504-505, EU422996, EU418506, EU753185-187, and EU828528. The discovery of these additional MHC class I A sequences indicates a greater diversity and polymorphism of Chinese rhesus macaques in different geographic locations. As the set of Mamu-A alleles in Chinese rhesus macaques differs from the alleles of Indian animals, more work still needs to be carried out to identify these new allele-restricted immune responses with regard to vaccine studies.
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Affiliation(s)
- X Ma
- Center for Vaccines and Biotherapeutics, Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
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Zhang XN, Xu J, Tang LH, Gong J, Yan XY, Zhang Q. Influence on intestinal mucous permeation of paclitaxel of absorption enhancers and dosage forms based on electron spin resonance spectroscopy. Pharmazie 2007; 62:368-71. [PMID: 17557746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this paper is to investigate the permeation mechanism of the hydrophobic drug, paclitaxel in intestinal membranes of mice in relation to enhancers and preparation factors. The alteration fluidity of lipid and protein in mucous membrane were determined using electron spin resonance (ESR) when the membrane was treated with several enhancers including Pluronic F68, polyethylene glycol (PEG), Brij78 and lecithin. At the same time, the enhanced permeation of paclitaxel across the intestinal intercellular membrane of stratum corneum was studied for three formulations: inclusion complex, microemulsion and injection. The results showed that use of paclitaxel-hydroxypropyl-beta-cyclodextrin inclusion complexation and of paclitaxel microemulsion as vehicle and PEG 1500 as enhancer could significantly increase the permeation kinetics of paclitaxel in a fluid diffusion study. The effect on absorption characteristics of enhancing permeation of this hydrophobic drug in the intestinal mucosa was considered in the light of the change in membrane fluid.
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Affiliation(s)
- X N Zhang
- College of Pharmacy, Soochow University, DuShuHu High Education Zone, Su Zhou, Jiang Su Province, People's Republic of China.
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Brenner B, Shah MA, Karpeh MS, Gonen M, Brennan MF, Coit DG, Klimstra DS, Tang LH, Kelsen DP. A phase II trial of neoadjuvant cisplatin-fluorouracil followed by postoperative intraperitoneal floxuridine-leucovorin in patients with locally advanced gastric cancer. Ann Oncol 2006; 17:1404-11. [PMID: 16788003 DOI: 10.1093/annonc/mdl133] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the efficacy and toxicity of neoadjuvant chemotherapy with intravenous (i.v.) cisplatin and fluorouracil (5-FU), surgery and postoperative intraperitoneal (i.p.) floxuridine (FUdR) and leucovorin (LV) in patients with locally advanced gastric cancer. PATIENTS AND METHODS Preoperative staging was confirmed by laparoscopy (LAP). Two cycles of i.v. cisplatin (20 mg/m(2)/day, rapid infusion) and 5-FU (1000 mg/m(2), continuous 24-h infusion), given on days 1-5 and 29-34, were followed by a radical gastrectomy and a D2 lymphadenectomy. Patients having R0 resections were to receive three cycles of i.p. FUdR (1000 mg/m(2)) and LV (240 mg/m(2)), given on days 1-3, 15-17 and 29-31. Intraperitoneal chemotherapy was begun 5-10 days from surgery. RESULTS Thirty-eight patients were treated. Both preoperative and postoperative chemotherapy were well tolerated. T stage downstaging (pretreatment LAP versus surgical pathological stage) was seen in 23% of patients. The R0 resection rate was 84%. Neither an increase in postoperative morbidity nor operative mortality was noted. With a median follow-up of 43.0 months, 15 patients (39.5%) are still alive (median survival 30.3 months). Good pathologic response, seen in five patients (15%), was associated with better survival (P = 0.053). Peritoneal and hepatic failures were found in 22% and 9% of patients, respectively. Quality of life seemed to be preserved. CONCLUSIONS Neoadjuvant cisplatin/5-FU followed by postoperative i.p. FUdR/LV can be safely delivered to patients undergoing radical gastrectomy and D2 lymphadenectomy. The R0 resection and the survival rates are encouraging. An association between pathologic response and patient outcome was suggested.
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Affiliation(s)
- B Brenner
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Cornell University of New York, New York 10021, USA
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Hwang UW, Tang LH, Kobayashi M, Yong TS, Ree HI. Molecular evidence supports that Anopheles anthropophagus from China and Anopheles lesteri from Japan are the same species. J Am Mosq Control Assoc 2006; 22:324-6. [PMID: 16878417 DOI: 10.2987/8756-971x(2006)22[324:mestaa]2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The Hyrcanus group of Anopheles consists of many related species, of which An. sinensis, An. lesteri, and An. anthropophagus are known as malaria vector species. It is not possible to identify these species morphologically in the adult and larval stages. Nucleotide sequence alignment of 2nd internal transcribed spacer (ITS2) regions from 4 specimens of An. lesteri collected in Japan, 2 specimens of An. anthropophagus collected in China, and 1 specimen of An. sinensis collected in Korea were sequenced and compared. Sequences of ITS2 regions varied only at 4 sites between An. lesteri and An. anthropophagus, and individual variations among each An. lesteri and An. anthropophagus were found at 5 and 7 sites, respectively, whereas sequences varied at 161 sites between An. lesteri and An. sinensis. This molecular evidence strongly supports that An. lesteri from Japan and An. anthropophagus from China are the same species.
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Affiliation(s)
- U W Hwang
- Department of Biology, Teachers College, Kyungpook National University, Taegu 702-701, Korea
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