Cardiopulmonary Function Research Articles

Application of Cardiac Rehabilitation Aerobic Exercise in Patients with Stable Angina in Coronary Heart Disease.

Aims/Background A novel exercise protocol for cardiac rehabilitation aerobic (CRA) has been developed by Hebei Sport University, demonstrating efficacy in patients with coronary heart disease (CHD). The objective of this study was to evaluate the impact of CRA on precise cardiac rehabilitation (CR) for CHD patients presenting with stable angina pectoris. Methods The study cohort comprised patients with stable angina who were categorized into three groups: the CRA group (n = 35), the power bicycles (PB) group (n = 34), and the control group (n = 43). In addition to standard treatment, the CRA group underwent a 12-week CRA-based CR intervention, while the PB group participated in a similar program centered on PB exercise, and the control group received only standard treatment. Results At the end of the 12-week intervention, significant differences were observed among the groups in several physiological parameters, including systolic blood pressure (SBP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), Glycated Haemoglobin (Hb-A1c), peak oxygen uptake (Peak VO2), anaerobic threshold (AT), and Peak VO2/heart rate (HR) (p < 0.05). Both the CRA and PB groups showed significant reductions in SBP, FBG, TG, TC, LDL, and Hb-A1c compared to the control group (p < 0.05). Additionally, both groups exhibited significant improvements in Peak VO2, AT, and Peak VO2/HR (p < 0.05). Intra-group analysis revealed that the CRA group showed significant improvements from baseline to post-intervention in SBP, diastolic blood pressure (DBP), FBG, TG, TC, high-density lipoprotein (HDL), LDL, Hb-A1c, Peak VO2, AT, and Peak VO2/HR (p < 0.05). Similarly, the PB group demonstrated significant improvements across these parameters (p < 0.05). Conclusion Both CRA and PB exercises are safe and effective for achieving precise CR in patients with CHD. A 12-week CRA intervention, conducted three times per week for 30 minutes per session, significantly improves cardiopulmonary function and biochemical makers in patients with stable angina. These improvements are comparable to those achieved through PB exercise in precise CR.

TARGETING LUNG HEME IRON BY AEROSOL HEMOPEXIN ADMINSTRATION IN SICKLE CELL DISEASE PULMONARY HYPERTENSION.

Lung tissue from human patients and murine models of sickle cell disease pulmonary hypertension (SCD-PH) show perivascular regions with excessive iron accumulation. The iron accumulation arises from chronic hemolysis and extravasation of hemoglobin (Hb) into the lung adventitial spaces, where it is linked to nitric oxide depletion, oxidative stress, inflammation, and tissue hypoxia, which collectively drive SCD-PH. Here, we tested the hypothesis that intrapulmonary delivery of hemopexin (Hpx) to the deep lung is effective at scavenging heme-iron and attenuating the progression of SCD-PH. Herein, we evaluated in a murine model of hemolysis driven SCD-PH, if intrapulmonary Hpx administration bi-weekly for 10 weeks improves lung iron deposition, exercise tolerance, cardiovascular function, and multi-omic indices associated with SCD-PH. Data shows Hpx delivered with a micro-sprayer deposits Hpx in the alveolar regions. Hpx extravasates into the perivascular compartments but does not diffuse into the circulation. Histological examination shows Hpx therapy decreased lung iron deposition, 4-HNE, and HO-1 expression. This was associated with improved exercise tolerance, cardiopulmonary function, and multi-omic profile of whole lung and RV tissue. Our data provides proof of concept that treating lung heme-iron by direct administration of Hpx to the lung attenuates the progression of PH associated with SCD.

Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric patients: A Prospective Pilot Study.

The physiologic benefits of the minimally invasive repair of pectus excavatum (MIRPE) on cardiopulmonary function are poorly understood in pediatrics. We sought to examine the effects of MIRPE on exercise response during cardiopulmonary exercise testing (CPET). A prospective-pilot study was conduct of patients ≤18 years who presented for pectus bar removal. All patients had CPET prior to MIRPE and following bar removal. Paired sample T tests were used to compare pre- and post-MIRPE CPET results. Twenty-five patients completed post-MIRPE CPET (72% male, median age 18.6 [IQR:17.5-19.8]). The median Haller and correction indices were 4.5 and 29.4%, respectively. There was significant increase in O2Pulse, (10.3 vs 12.1mL/beat, p=0.004), and percent predicted O2Pulse (79.5% vs 84.4%, p=0.046) following MIRPE/bar removal. The peak-VO2/kg and did not change significantly following MIRPE/bar removal; however, peak-VO2 (ml/min) increased. Patients with decreased activity levels at time of bar removal compared to pre-MIRPE had decreased peak-VO2/kg and predicted peak-VO2/kg. Following MIRPE, patients experience increased in O2Pulse, which is a surrogate measure of stroke volume response to exercise and may reflect relief of cardiac compression. Cardiopulmonary function is multifactorial and despite improvement in stroke volume, other factors may impact exercise capacity (VO2) following MIRPE. Treatment Study. IV.

Association of Fontan Pathophysiology With Plasma Bile Acids.

Patients with Fontan circulation are frail and experience multisystem dysfunction including impaired exercise capacity, low resting and exercise-augmented cardiac output, and progressive liver fibrosis. However, common underlying biochemical abnormalities or disease-specific biomarkers have not been well-described. We wish to investigate Fontan and their matched healthy subjects using a nontargeted, followed by targeted metabolomic analysis. Patients with Fontan circulation were compared to age- and sex-matched healthy controls with regard to body composition, markers of frailty, cardiopulmonary exercise testing, and resting and exercise-augmented hemodynamics. Subsequently, the study participants underwent a nontargeted metabolomics assessment, followed by targeted plasma bile acid (BA) analysis. Twenty Fontan patients (28.8±9.8years of age; 35% women) and 20 healthy controls (29.7±6.0years of age; 30% women) were enrolled. Fontan patients had significantly lower skeletal muscle mass, took longer to complete the 5 times sit-to-stand test; achieved lower %VO2 max, and had lower resting and postexercise hemodynamic parameters. Nontargeted metabolomics assessment demonstrated elevated BAs, oxylipins, and leucine metabolites in Fontan patients. Total BA as well as 17 BA components were markedly elevated in the Fontan patients. Selective BAs were negatively associated with age, degree of frailty, cardiopulmonary function, and hemodynamic parameters. Elevated BAs are associated with worsening Fontan physiology. These findings warrant further exploration.

Examining the Influence of Omega-3 Fatty Acids on Performance, Recovery, and Injury Management for Health Optimization: A Systematic Review Focused on Military Service Members.

Omega-3 fatty acids (n-3), recognized for their anti-inflammatory and brain health benefits, are being studied to enhance cognitive function, aid physical recovery, and reduce injury rates among military service members (SMs). Given the unique demands faced by this tactical population, this systematic review aims to evaluate the evidence of n-3 to support physical and mental resilience and overall performance. This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and includes articles that assessed n-3 status or implemented n-3 interventions in relation to physical and cognitive performance, recovery, and injury outcomes (2006 to 2024). Of the 1606 articles yielded in screening through Covidence, 755 were irrelevant, leaving 226 studies for full-text eligibility. Of those 226 studies, 165 studies were excluded, and 61 studies were included in this review. The results highlighted evidence-based findings in five key areas where omega-3 fatty acids are being evaluated to benefit military service members. These key areas include cardiopulmonary function, exercise recovery, cognitive function, injury recovery, and strength and power. While existing research suggests promising benefits, the most significant evidence was seen with cardiopulmonary function, exercise recovery, and cognitive function. Current research is promising and shows potential benefits, but the results are inconclusive and inconsistent. Future research is needed to determine optimal n-3 status, dose, and possibly type of n-3 across the various performance outcomes. Understanding these gaps in research will be essential to creating evidence-based n-3 guidelines for optimal performance of SMs.

Prognosis of bronchopulmonary dysplasia

Children with bronchopulmonary dysplasia (BPD) often exhibit severe respiratory problems and significant pulmonary dysfunction during school age and adulthood. Exercise tests show a decline in cardiopulmonary function and physical performance in children with BPD, who also have a higher incidence of pulmonary hypertension. These children generally perform poorly in terms of intelligence, language, and motor development. As they age, the risk of neurodevelopmental disorders increases, and health-related quality of life is also affected. This article reviews the prognosis of the respiratory system, physical capacity, cardiovascular system, nervous system, and health-related quality of life in children with BPD, aiming to improve the management of these patients and enhance their subsequent quality of life.

Association of Pulmonary Involvement at Baseline with Exercise Intolerance and Worse Physical Functioning 8 Months Following COVID-19 Pneumonia.

Objectives: We aimed to describe the cardiopulmonary function during exercise and the health-related quality of life (HRQoL) in patients with a history of COVID-19 pneumonia, stratified by chest computed tomography (CT) findings at baseline. Methods: Among 77 consecutive patients with COVID-19 who were discharged from the Pulmonology Ward between March 2020 and April 2021, 28 (mean age 54.3 ± 8.6 years, 8 females) agreed to participate to the current study. The participants were analyzed in two groups based on pulmonary involvement (PI) at baseline chest CT applying a threshold of 25%. A consequent artificial intelligence (AI)-guided total opacity score (TOS) was calculated in a subgroup of 22 patients. A cardiopulmonary exercise test (CPET) was conducted on average 8.4 (±1.9) months after discharge from the hospital. HRQoL was defined using the short-form (SF-36) questionnaire. The primary outcome was exercise intolerance that was defined as a peak oxygen uptake (V'O2peak) < 80% predicted. Secondary outcomes were ventilatory limitation, defined as breathing reserve < 15%, circulatory limitation, defined as oxygen pulse predicted below 80%, and deconditioning, defined as exercise intolerance in the absence of ventilatory and circulatory limitations. Other secondary outcomes included the SF-36 domains. Results: In all, 15 patients had at least 25% PI (53.6%) at baseline chest CT. Exercise intolerance was observed in ten patients (35.7%), six due to deconditioning and four due to circulatory limitation; none had ventilatory limitation. AI-guided TOS was 30.1 ± 24.4% vs. 6.1 ± 4.8% (p < 0.001) at baseline, and 1.7 ± 3.0% vs. 0.2 ± 0.7% (nonsignificant) at follow-up in high and low PI groups, respectively. The physical functioning (PF) domain score of the SF-36 questionnaire was 66.3 ± 19.4 vs. 85.0 ± 13.1 in high and low PI groups, respectively (p = 0.007). Other SF-36 domains did not differ significantly between the groups. A high PI at baseline was inversely correlated with V'O2peak (standardized β coefficient = -0.436; 95% CI -26.1; -0.7; p = 0.040) and with PF scores (standardized β coefficient -0.654; 95% CI -41.3; -7.6; p = 0.006) adjusted for age, sex, body mass index and lung diffusion capacity. Conclusions: One-third of participants experienced exercise intolerance eight months after COVID-19 pneumonia. A higher PI at baseline was significantly associated with exercise intolerance and PF. Notwithstanding, the radiological PI was resolved, and the exercise intolerance was mainly explained not by ventilatory limitation but by circulatory limitation and deconditioning.

Exercise capacity and the psychosocial effect in preterm born infants - Should we do more?

Physical activity is crucial for children's physical, cognitive, and social development, reducing the risk of non-communicable diseases and improving overall well-being. A major legacy of extremely preterm delivery is respiratory limitation with reduced lung function and decreased exercise capacity which can be further exacerbated by inactivity and deconditioning. Strategies to increase incidental physical activities in early childhood and participation in sport and more formal exercise programmes in middle childhood have the potential to optimize cardiopulmonary function, improve quality of life, and foster social interactions in childhood and beyond, thereby providing benefits that extend far beyond the physical domain. Intervention strategies such as supervised aerobic and resistance training, and incorporation of physical activity into daily routines have shown promise in increasing activity levels and improving exercise capacity in this population. Engaging families and tailoring programs to individual needs are crucial for the success of these interventions. Overall, a holistic approach that promotes increased physical activity and addresses psychosocial barriers is essential for optimizing the health, well-being, and quality of life of preterm-born children. Further research and development of effective, long-term intervention programs are needed to support these vulnerable individuals throughout childhood and into adulthood.

Study on the stability and accuracy of the new Booster portable cardiopulmonary function meter

Study on the stability and accuracy of the new Booster portable cardiopulmonary function meter

Urinary titin reflects the severity of walking ability, muscle strength, and muscle and cardiac damage in patients with Becker muscular dystrophy.

Becker muscular dystrophy (BMD) is a dystrophinopathy caused by a pathological variant of the DMD gene. Urinary titin, a degradation product of the giant protein titin present in muscle sarcomeres, has been used as a biomarker to reflect muscle degradation in Duchenne muscular dystrophy, a more severe dystrophinopathy. However, the clinical significance of urinary titin levels in BMD remains unclear. This study aimed to investigate the relationship between urinary titin levels and the clinical data in patients with BMD. Urine samples were collected from 123 patients with BMD, and urinary titin levels were measured. The association of urinary titin with clinical data, including age, physical measurements, physical activity, blood tests, and cardiopulmonary test results, was examined. A total of 257 urine samples were obtained from patients of 5-79years of age. The median urinary titin level was 72.6pmol/mg Cr (range 0.2-4325.0pmol/mg Cr). No strong correlation was found between urinary titin levels and age, physical measurements, physical function, blood test results, or cardiopulmonary function. However, on comparing clinical data between the age-matched high urinary titin (N=94) and normal (N=29) groups, the high urinary titin group had a significantly greater number of non-ambulatory cases (23.9% vs. 3.6%), weaker grip strength (16.3 vs. 32.0kg), and higher serum creatine kinase (1072 vs. 398 U/L) and cardiac troponin I (10.6 vs. 2.5pg/mL) levels. Urinary titin was identified as a biomarker reflecting walking ability, muscle strength, and skeletal and cardiac damage in patients with BMD.

The Use of Ultrasonography in Improving The Success of Rehabilitation Process in ICU

Complications of various degenerative and genetic diseases on physical fitness can occur directly and indirectly. Indirect causes are due to prolonged immobilization, leading to reduced functional capacity. Direct causes may involve diseases that result in decreased cardiac and pulmonary function. Prolonged ventilator use in the ICU might significantly reduce cardiopulmonary function and even high risk in ventilator weaning challenging for patients. One of the newest method to assess pulmonary function in the ICU is ultrasonography, which evaluates the diaphragmatic muscle function in ventilator-dependent patients. This method has been applied in several educational hospitals and hopefully might improve our capacity as physiatrist. Cardiorespiratory fitness is achieved through regular and continuous exercise. Cardiac and pulmonary rehabilitation is carried out from the acute phase to the community. Rehabilitation conducted in the ICU is a supportive and essential rehabilitation process. Why? Because the ICU rehabilitation stage can have a tremendous effect on improving weaning ventilation ability. Preservation and improvement of lung function and cardiopulmonary function allow patients to wean faster and increase their level of mobilization.

Effects of physical therapy via telerehabilitation on cardiopulmonary, physical and psychological function in patients with coronavirus disease 2019: A randomised controlled trial

Objectives To compare the effects of physical therapy via telerehabilitation on the improvement in cardiopulmonary function, physical factors and psychological factors in patients with coronavirus disease 2019 (COVID-19). Methods Thirty-two patients with COVID-19 were randomly assigned to intervention and control groups. Both groups received online guidance and a leaflet on cardiopulmonary rehabilitation. Additionally, participants in the intervention group received physical therapy training via video call, which included pulmonary training and various exercises. Cardiopulmonary exercise testing, quality of life, functional capacity, cognitive function, lower body strength and endurance and psychological aspects (anxiety, depression and insomnia) were assessed. Results The physical therapy programme delivered via telerehabilitation significantly improved cardiopulmonary function in patients with COVID-19 at the 3-month follow-up compared with the control group. Additionally, the physical therapy programme had beneficial effects on functional capacity, depression symptoms and quality of life. Conclusion A physical therapy programme via telerehabilitation can be delivered to patients with COVID-19 in their own homes to improve cardiopulmonary function after 3 months of follow-up.

Quality of Life Assessment Following Direct Total Cavopulmonary Connection in Fontan Circulation: A Single Center Cross-Sectional Study

Background: This study aims to compare the long-term outcomes and quality of survival between the direct total cavopulmonary connection (dTCPC) procedure and the standard extracardiac conduit (ECC) procedure in Fontan patients. Methods: A total of 31 participants who underwent the Fontan operation with either ECC (n = 15) or dTCPC (n = 16) at our institution were recruited between May 2023 and October 2023. Comprehensive evaluations included physical examinations, blood tests, targeted plasma metabolomics assays, cardiopulmonary exercise testing (CPET), and cardiac magnetic resonance imaging (CMR). Data collected from these assessments were analyzed and compared between the two groups. Results: The mean follow-up duration was longer in the dTCPC group (174.25 ± 63.06 months) compared to the ECC group (144.00 ± 43.70 months). No significant differences were observed in blood test parameters between the groups (p &gt; 0.05). During CPET, two patients in the dTCPC group (12.5%) terminated the experiment due to a sudden decrease in exercise tolerance during the cycling process. Peak VO2 values were comparable between groups, with 20.29 ± 7.40 mL/min/kg in the dTCPC group versus 19.10 ± 7.93 mL/min/kg in the ECC group (p = 0.5939). Cardiac output in CMR revealed no significant differences between the two groups (5.28 ± 3.20 vs. 5.40 ± 2.85, p &gt; 0.05). Additionally, flow measurements within the Fontan structure showed no significant differences (2.042 ± 1.0 vs. 2.023 ± 1.0], p &gt; 0.05). Plasma metabolic profiling using targeted metabolomics demonstrated that the metabolic profiles of the two groups were broadly similar. Conclusions: The dTCPC procedure demonstrated similar outcomes to the ECC procedure in terms of exercise cardiopulmonary function, blood flow in central great vessels and plasma metabolic profiles. However, the long-term survival quality following dTCPC surgery, particularly regarding exercise capacity, may not fully meet expectations, highlighting the need for further refinement in surgical techniques and postoperative management.

Association of Physiological Reserve Obtained from Cardiopulmonary Exercise Testing and Frailty with All-Cause Mortality in Patients on Hemodialysis.

Potential impairment of exercise capacity is prevalent even in patients undergoing hemodialysis without frailty. Cardiopulmonary exercise testing (CPET) can detect physiological reserves such as cardiopulmonary, muscle, and autonomic function. We hypothesized that these indices could accurately determine the prognosis of patients on hemodialysis and analyzed them based on their relationship to frailty. In this two-center prospective cohort study hemodialysis patients from Japan, participants underwent CPET and physical assessment to evaluate peak oxygen uptake (peak VO2, indicator of exercise capacity), peak work rate (WR, indicator of muscle function), ventilatory equivalent for carbon dioxide (VE/VCO2) slope (indicator of cardiac reserve), heart rate reserve (indicator of chronotropic incompetence), and frailty phenotype. Survival was followed-up for up to 5 years. Data from 189 patients (median [IQR] age: 71 [62, 77] years) were analyzed. All CPET indicators showed a consistent nonlinear relationship with all-cause mortality after adjustment: for peak VO2, hazard ratio [HR] 0.79 [95% CI: 0.71, 0.88], P <0.001; for peak WR, HR 0.95 [95% CI: 0.93, 0.97], P <0.001; for VE/VCO2 slope, HR 1.09 [95% CI: 1.05, 1.13], P <0.001; for heart rate reserve, HR 0.96 [95% CI: 0.93, 0.99], P=0.02). Frailty phenotype was associated with mortality after adjustment (HR 1.73 [95% CI: 1.06, 2.81], P=0.03); however, this association was not statistically significant in the model after adding peak VO2 (P=0.41). Furthermore, in both subgroups with and without frailty, CPET measures were significantly associated with mortality risk (peak VO2, peak WR, and VE/VCO2 slope: P <0.05). The peak VO2 (Δ area under the curve [AUC] 0.09, 95% CI: 0.02, 0.16) or the peak WR (ΔAUC 0.09, 95% CI: 0.02, 0.15) most significantly improved the prognostic accuracy. Results showed the fragile aspect of the frailty phenotype in the hemodialysis population and the superior ability of CPET to indicate death risk complementing that aspect.

Effect of Bio-Electro-Magnetic-Energy-Regulation (BEMER) Horse Therapy on Cardiopulmonary Function and Recovery Quality After Isoflurane Anesthesia in 100 Horses Subjected to Pars-Plana Vitrectomy: An Investigator-Blinded Clinical Study.

The use of Bio-Electro-Magnetic-Energy-Regulation (BEMER) therapy during general anesthesia has not previously been reported in horses. This randomized, investigator-blinded, placebo-controlled trial evaluates equine cardiopulmonary function and recovery quality after BEMER therapy application for 15 min in 100 horses during general anesthesia using isoflurane for pars-plana vitrectomy surgery as treatment for recurrent uveitis. Visually identical blankets were used in the two groups (1:1 ratio), one with a functional BEMER module and the other with a placebo module. Arterial blood pressure, blood gas, lactate, and creatine kinase (CK) values were measured at different timepoints, and each timepoint was compared between the groups using paired t-tests. The quality of recovery from anesthesia was assessed by one blinded veterinary surgeon using a 10-category scoring system with scores ranging from 10 (best) to 72 (worst) and compared by an ordinary least squares regression analysis. The placebo group had a significantly better recovery (mean 16.1, standard deviation 7.15) than the BEMER-therapy group (mean 22.4, SD 13.0). Arterial blood pressure and blood lactate were lower in the BEMER-therapy group without reaching statistical significance, while CK and blood gas values were comparable. BEMER-horse therapy showed an effect on the recovery quality of horses undergoing general anesthesia.

Effects of NUSS surgery on degree of flat thoracic cage, cardiopulmonary function, and bone metabolism in pectus excavatum patients of different ages.

This study was to explore the degree of flat thoracic cage (FTC), cardiopulmonary function, and bone metabolism of pectus excavatum (PE) children of different ages after NUSS surgery. A retrospective analysis was conducted on 90 children with PE who underwent minimally invasive pectus excavatum correction surgery (NUSS), divided into three age groups: group I (1-3years), group II (3-6years), and group III (6-12years), with 30 patients in each group. The study compared differences in thoracic flattening index, surgical-related metrics, pulmonary function, peripheral blood levels of alkaline phosphatase (ALP), calcium, magnesium, zinc, and phosphorus, and complication rates among the groups. Preoperative ALP level increased with aging of the children (P < 0.05). After surgery, the FTC index and ALP level of all the three groups greatly decreased, but increased with aging (P < 0.05). The operating time, intraoperative blood loss, and postoperative duration of analgesia also showed a trend of group III > group II > group I (P < 0.05). Postoperative levels of pulmonary function, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), peak expiratory flow (PEF), maximum expiratory flow at 75% of vital capacity (MEF75), maximum expiratory flow at 50% of vital capacity (MEF50), maximum expiratory flow at 25% of vital capacity (MEF25), and maximal mid-expiratory flow (MMEF), were significantly higher than preoperative levels in group I (P < 0.05); but without significant changes in groups II and III (P > 0.05). Neglectable differences were found in peripheral blood Ca, Mg, Zn, and P levels before and after surgery and postoperative complications in three groups (P > 0.05). The degree of FTC worsened with aging; the younger the children receiving NUSS surgery are, the more obvious the improvement of postoperative PF.

Persistent and severe hypotension during radical transabdominal ovarian cancer surgery: A case report.

In radical surgery for ovarian cancer (OC), hypotension that is difficult to correct is usually rare unless there is significant blood loss. We recently encountered a patient who developed persistent and severe hypotension during radical transabdominal OC surgery. A patient was 52 years old with a history of hypertension and well-controlled preoperative blood pressure (BP). A total of 2000 mL of ascites was drained and blood loss was 300 mL when the operation proceeded to 5.5 hours. The patient's cardiopulmonary function and blood gas analysis showed no significant abnormalities. persistent and uncorrectable hypotension. There was no significant edema in the patient's head or face, nor did the surgeon observe noticeable edema in her intestinal walls or other organs. No oozing was seen at the surgical site. Fluid resuscitation and vasopressor administration were continued. As BP control further deteriorated, blood counts, coagulation, and biochemical electrolyte analyses revealed severe hypoalbuminemia (13.5 g/L) and coagulation dysfunction. After intravenous human serum albumin (HSA) and fresh frozen plasma therapy, her hypoalbuminemia and coagulation were gradually corrected. Based on this case, we suggest that in OC patients experiencing mild intraoperative bleeding and minimal heart rate variation but persistent refractory hypotension, hypoalbuminemia should be considered even if preoperative biochemical tests (including serum albumin levels) are normal. Confirming hypoalbuminemia warrants HSA administration to alleviate hypovolemic shock symptoms. Additionally, it is important to be cautious of potential coagulation issues with albumin use, possibly requiring plasma infusion to address coagulopathy.

Study on the role of postoperative rehabilitation based on the ERAS concept for patients undergoing pancreaticoduodenectomy: Protocol for a randomized controlled clinical trial.

Pancreaticoduodenectomy (PD), an abdominal surgery, is known for its complexity, cost and inherent risks. Recently, there has been increasing interest in enhanced recovery after surgery (ERAS) as a therapeutic approach. However, the mechanisms underlying postoperative functional recovery remain uncertain, and there are limited data on the efficacy of ERAS in postoperative physiotherapy following complex PD. This study aims to examine the feasibility and effectiveness of conducting a large powered randomized controlled trial (RCT) to evaluate a 2-week postoperative rehabilitation program based on the ERAS concept for patients undergoing pancreaticoduodenectomy. This study is a RCT with a single treatment group. From June 2022 to June 2024, 28 PD patients will participate in the trial. Patients will be randomly assigned to either a control group receiving standard clinical care or an intervention group undergoing a 2-week postoperative rehabilitation program. Cardiopulmonary function will be assessed using the 6-minute walk test (6MWT), and gastrointestinal (GI) recovery will be evaluated using the Intake, Feeling nausea, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system. Secondary outcomes, including changes in recovery quality post-surgery, will be evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and the Quality of Recovery Questionnaire (QOR-40). Additional recorded items will include time to first flatus and feces, daily volume of stomach fluid, time to gastric tube removal, length of hospital stay (LOS), and postoperative complications. The study will utilize the I-FEED score, a novel tool for assessing GI function, to monitor the impact of a 2-week postoperative rehabilitation exercise program on patients. The primary outcome will focus on improvements in cardiopulmonary capacity following postoperative rehabilitation activities.

Whole-genome resequencing to investigate the genetic diversity and mechanisms of plateau adaptation in Tibetan sheep

IntroductionTibetan sheep, economically important animals on the Qinghai–Tibet Plateau, have diversified into numerous local breeds with unique characteristics through prolonged environmental adaptation and selective breeding. However, most current research focuses on one or two breeds, and lacks a comprehensive representation of the genetic diversity across multiple Tibetan sheep breeds. This study aims to fill this gap by investigating the genetic structure, diversity and high-altitude adaptation of 6 Tibetan sheep breeds using whole-genome resequencing data.ResultsSix Tibetan sheep breeds were investigated in this study, and whole-genome resequencing data were used to investigate their genetic structure and population diversity. The results showed that the 6 Tibetan sheep breeds exhibited distinct separation in the phylogenetic tree; however, the levels of differentiation among the breeds were minimal, with extensive gene flow observed. Population structure analysis broadly categorized the 6 breeds into 3 distinct ecological types: plateau-type, valley-type and Euler-type. Analysis of unique single-nucleotide polymorphisms (SNPs) and selective sweeps between Argali and Tibetan sheep revealed that Tibetan sheep domestication was associated primarily with sensory and signal transduction, nutrient absorption and metabolism, and growth and reproductive characteristics. Finally, comprehensive analysis of selective sweep and transcriptome data suggested that Tibetan sheep breeds inhabiting different altitudes on the Qinghai–Tibet Plateau adapt by enhancing cardiopulmonary function, regulating body fluid balance through renal reabsorption, and modifying nutrient digestion and absorption pathways.ConclusionIn this study, we investigated the genetic diversity and population structure of 6 Tibetan sheep breeds in Qinghai Province, China. Additionally, we analyzed the domestication traits and investigated the unique adaptation mechanisms residing varying altitudes in the plateau region of Tibetan sheep. This study provides valuable insights into the evolutionary processes of Tibetan sheep in extreme environments. These findings will also contribute to the preservation of genetic diversity and offer a foundation for Tibetan sheep diversity preservation and plateau animal environmental adaptation mechanisms.

Effects of Heart Rate Fluctuation on Aerobic Training Outcomes in Patients With Stable Coronary Artery Disease: A Prospective Study.

This study aimed to evaluate the effects of different heart rate fluctuation ranges during aerobic training on outcomes in patients with stable coronary artery disease (CAD). Ninety-seven patients diagnosed with stable CAD were enrolled between March 2017 and December 2019. Participants were randomly assigned to three groups: the control (CON) group, the medium-intensity heart rate small range (MIS) group, and the medium-intensity heart rate large range (MIL) group. The CON group received standard care and patient education, while the MIS and MIL groups underwent personalized rehabilitation training with specific heart rate fluctuation targeted ranges, in addition to standard care. Cardiopulmonary function and exercise performances were assessed using resting heart rate (RHR), maximum heart rate (HRmax), heart rate recovery (HRR), and a 6-min walk test (6MWT) at the baseline and after 16 weeks of training. The MIS group demonstrated a significant reduction in RHR compared to the CON and MIL groups. While both exercise rehabilitation groups exhibited improvement in HRR, only the MIS group achieved a statistically significant improvement compared to the CON group. Post-training HRmax and 6MWT performance increased in both MIS and MIL groups, with only the MIL group presenting statistical significance compared to the CON group. Exercise rehabilitation with different training regimens can enhance cardiac function in patients with CAD. Different heart rate modulation strategies yielded distinct effects on cardiopulmonary function. Maintenance of a narrower heart rate fluctuation during exercise was observed to significantly enhance the effectiveness of rehabilitation, which could lead to new treatment protocols or optimization of existing strategies for patients with cardiovascular conditions. The combination of 6MWT and power bicycle training may offer an effective method for improving cardiac function in community-based rehabilitation settings.