Changes In Cardiopulmonary Function Research Articles

Wearable Device–Based Intervention for Promoting Patient Physical Activity After Lung Cancer Surgery

ImportanceEmerging evidence suggests that wearable devices are feasible for monitoring physical activity among patients with lung cancer. However, the association between wearable devices and improvement in patient recovery after surgery remains underexplored.ObjectiveTo evaluate the effects of a wearable device intervention on the recovery of physical activity, cardiopulmonary function, and health-related quality of life (HRQOL) after lung cancer surgery.Design, Setting, and ParticipantsThis nonrandomized clinical trial with a historical control was conducted at a single tertiary cancer center (Samsung Comprehensive Cancer Center) in Seoul, South Korea, between October 18, 2018, and May 24, 2019. Patients were included if they had suspected or confirmed non–small cell lung cancer scheduled for curative surgery more extensive than lobectomy and had an Eastern Cooperative Oncology Group status of 0 or 1. Patients were compared with historical control participants from data collected between September 20, 2017, and September 10, 2018, as part of the Coordinated Approach to Cancer Patients’ Health for Lung Cancer (CATCH-LUNG) prospective cohort study. Data analysis was performed between June 21 and July 16, 2020.InterventionA personalized exercise regimen monitored via a wearable device was administered to intervention patients at home in 3 stages: preoperative (from diagnosis to surgery), immediate (from discharge to 2 months after surgery), and later postoperative (from 2 to 6 months after surgery). Control patients received usual care.Main Outcomes and MeasuresThe primary outcome was cardiopulmonary function, and the co–primary outcome was physical activity at 6 months after surgery, measured with 6-minute walking distance (6MWD) and number of daily steps, using a linear regression model. Secondary outcomes were changes in cardiopulmonary function, physical activity, and HRQOL, including function and symptoms from baseline to 2 weeks and 6 months after surgery. Additionally, cardiopulmonary function and physical activity (number of daily steps and time spent on moderate-to-vigorous physical activity [MVPA]) at 2 weeks after surgery, physical activity (time spent on MVPA) at 6 months after surgery, and HRQOL, including function and symptoms at 2 weeks and 6 months after surgery, were assessed as secondary outcomes.ResultsThis trial included 74 patients in the intervention group (mean [SD] age, 60.4 [8.7] years; 31 [41.9%] men and 43 [58.1%] women) and 120 in the control group (mean [SD] age, 60.2 [8.7] years; 65 [54.2%] men and 55 [45.8%] women). Daily steps, MVPA, and 6MWD decreased initially at 2 weeks after surgery but increased thereafter. The control group had a larger decrease in the number of daily steps from baseline compared with the intervention group (−4877 [95% CI, −5861 to −3893] steps vs −1753 [95% CI, −2968 to −539] steps) at 2 weeks after surgery. By 6 months after surgery, the intervention group increased their daily steps by 2220 (95% CI, 1006 to 3435) from baseline, whereas the control group did not return to their baseline number of steps. The intervention group had significantly more daily steps (12 321 [95% CI, 8749-15 761] vs 10 118 [95% CI, 7341-13 420]; P = .007) and had greater vigorous physical activity (33.6 [95% CI, 13.5 to 59.8] vs 18.5 [5.7 to 40.8] minutes; P = .003) at 6 months after surgery compared with the control group. No difference in 6MWD was found. However, the intervention group had better patient-reported physical function (mean [SD] score, 82.2 [17.3] vs 76.9 [17.5]; P = .04), less dyspnea (mean [SD] score, 24.8 [27.1] vs 34.5 [31.6]; P = .03), and less pain (mean [SD] score, 21.4 [20.2] vs 30.1 [26.8]; P = .01) at 2 weeks after surgery and less dyspnea (mean [SD] score, 5.4[12.4] vs 12[23.3]; P = .01) at 6 months after surgery compared with the control group.Conclusions and RelevanceIn this nonrandomized clinical trial, integration of perioperative exercise interventions using wearable devices improved physical activity (especially MVPA) and dyspnea at 6 months after lung cancer surgery compared with usual care. This finding suggests a promising role for wearable devices in personalizing perioperative rehabilitation strategies.Trial RegistrationClinicalTrials.gov Identifier: NCT03215537

Robotic Pediatric Urologic Surgery-Clinical Anesthetic Considerations: A Comprehensive Review.

Minimally invasive robotic approaches have become standard in many institutions over the last decade for various pediatric urological procedures. The anesthetic considerations for common laparoscopic and robotic-assisted surgeries are similar since both require the insufflation of CO2 to adequately visualize the operative area. However, few studies exist regarding anesthesia for robotic procedures in children. We hypothesized that pediatric patients undergoing robotic urologic surgeries would require specific anesthetic strategies, especially given the inherently longer durations of these procedures. This study aimed to evaluate anesthetic considerations, current robotic procedures, optimal patient positioning, and port placement for robotic-assisted surgery in pediatric patients. A comprehensive literature review of all published manuscripts from PubMed, EMBASE database, and Google Scholar was performed, focusing on robotic procedures involving pediatric patients, anesthesia for pediatric urology patients, and related topics from 1996 to 2023. Forty published manuscripts were identified and reviewed in depth. In pediatric cases, insufflation pressures and volumes are lower due to the laxity of the abdominal wall. However, the increase in intra-abdominal pressure and absorption of CO2 may result in disproportionate changes in cardiopulmonary function. Specific patient positioning for robotic approaches may further compound these physiological changes. Correct patient positioning is essential to facilitate surgery optimally and safely. Understanding the physiological changes that can occur during a pediatric patient's robotic urologic surgery allows for safer anesthesia management.

Factors associated with failure of cardiopulmonary function recovery after lung cancer surgery.

This study aimed to evaluate the longitudinal changes in cardiopulmonary function (CPF) and identify predictors of cardiopulmonary recovery failure after lung cancer surgery. Data was obtained from a prospective CATCH-LUNG cohort study, where patients were divided into two groups based on 6-min walk distance (6MWD) at baseline and 6 months after surgery. CPF recovery failure was defined as a participant whose 6MWD dropped over 50 m from baseline to 6 months after surgery. Patients with a baseline 6MWD less than 400 m were excluded. The analysis was investigated using mixed effects models, and the relative estimates for the predictors were expressed relative risk (RR) and 95% CI using a Poisson regression. Among 419 patients, 24.1% and 17.7% showed failure of CPF recovery at 6 months and 1 year after surgery, respectively. In the multivariable analysis, baseline step count [RR per 1000 steps lower = 1.05 (95% CI, 1.01-1.09)], baseline dyspnoea [RR per 10 points higher = 1.15(1.07-1.23)], decreased FEV1 % predicted from baseline to 2 weeks after surgery [RR per 10% lower = 1.30(1.10-1.53)] and decreased moderate-to-vigorous physical activity (MVPA) from baseline to 2 weeks [RR = 1.95(1.22, 3.11)] or persistent low MVPA at baseline and 2 weeks after surgery [RR = 1.63(1.04, 2.54)] were significant factors for loss of CPF. The inability to recover CPF at 6 months after surgery was linked to reduction of lung function and MVPA from baseline to 2 weeks as well as baseline physical activity (PA) and dyspnoea. These results imply that engagement of perioperative PA is necessary to facilitate recovery of CPF after lung cancer surgery.

서로 다른 cardiac rehabilitation protocol(RPE 11-13 and RHR+20) 이 급성 CABG 환자의 산소섭취율과 호흡기능개선에 미치는 효과

Purpose: The RPE 11-13 and RHR+20 methods are used to set exercise intensity for cardiac rehabilitation programs, which are usually performed during a 1-week hospital stay after coronary artery bypass grafting (CABG); however, studies quantifying the actual changes in cardiopulmonary function and inter-subject variability for each approach are limited.
 Methods: In this study, 50 patients (43 males and 7 females) with a mean age of 63.6 ± 8.8 years who participated in an inpatient cardiac rehabilitation program after CABG were eligible for inclusion. Of the 50 patients, 16 dropped out (six patients refused to exercise and 10 patients were discharged midway), and finally, 34 patients participated in this study. Cardiopulmonary function and handgrip strength were evaluated, and after 1 week of cardiac rehabilitation, the evaluation parameters were reevaluated at the outpatient visit.
 Results: Both the RHR+20 and RPE 11-13 groups showed a significant increase in the peak VO2 and a large effect size after cardiac rehabilitation (F[1,32]; p<.001; ηp2=.52), and overall, the RHR+20 group showed a higher peak VO2 t han the R PE 1 1-13 group (F[1,32]; p =.037; ηp2=.13). The RHR+20 group showed significantly greater improvements in the peak VO2 than the RPE 11-13 group and had a larger effect size (F[1,32]; p=.001; ηp2=.30).
 Conclusion: Studies applying different exercise protocols to patients with acute CABG are insufficient. However, in this study, the RHR+20 exercise protocol has been shown to be stable and effective for cardiac rehabilitation in patients after CABG.

Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison.

Objective: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery. Materials and Methods: A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation. Results: For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p < 0.05). In contrast, CVP, AWP, and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p < 0.001; p = 0.002; p = 0.004). The mean maximum CVP in the two groups was 20 and 16 mm Hg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p < 0.001; p < 0.001). Conclusions: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significant effects on IVC hemodynamics. Elevated intra-abdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significant increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effective way to control intravenous bleeding. Clinical Trial Registry: Registration number: ChiCTR2000038291.

ANÁLISE DA RESISTÊNCIA CARDIOPULMONAR SOB DIFERENTES CARGAS EM EXERCÍCIOS AERÓBICOS

ABSTRACT Introduction The key objective of aerobic exercise is enhancing cardiorespiratory endurance. On the national gymnastics plan implementation, the idea of lifelong sports was gradually accepted by the masses, and the aerobic gymnastics concept was sweeping the world. Objective Analyze the cardiorespiratory endurance responses in female college students under different frequencies in aerobic exercise. Methods 20 female professors and civilian women were randomly selected and divided into two groups. The experimental group performed 45 and 90 minutes of aerobic exercise to analyze changes in cardiopulmonary function before and after each exercise. Results After 16 weeks of aerobic exercise with different loads, all young women who had participated in the program training showed a significant increase in vital capacity and maximal oxygen uptake capacity. The vital capacity of the 90-min aerobic exercise group was significantly higher than that of the 45-min aerobic exercise group (P&lt;0.05). Conclusion The establishment of a cardiorespiratory endurance response model can accurately analyze the effects of different aerobic exercise frequencies on cardiorespiratory endurance. Evidence Level II; Therapeutic Studies – Investigating the results.

Effect of Simultaneous Multiplane Surgery on Cardiopulmonary Function in Patients with Moderate to Severe Obstructive Sleep Apnea-Hypopnea Syndrome and Its Curative Effect.

Objective To investigate the changes in cardiopulmonary function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by one-stage multiplane surgery. Methods 70 patients with moderate and severe OSAHS underwent nasal in our hospital from July 2017 to February 2021, palatopharyngeal, and/or tongue operations simultaneously and were followed up for 6 months. The Epworth Sleeping Scale (ESS) scores of patients before and after surgery were compared to observe the surgical efficacy, and the changes in the cardiopulmonary function of patients before and after surgery were detected. The static and dynamic indexes of cardiopulmonary function, respiratory disturbance index (AHI), and blood oxygen saturation (SaO2) were compared before and after the operation. Results After surgery, all patients' indexes of static lung function were improved compared with that before surgery. After surgery, the percentage of maximal oxygen uptake peak to the predicted value, percentage of oxygen pulse to the predicted value, the ratio of oxygen uptake power, anaerobic threshold, and maximum ventilatory capacity per minute/maximum exercise volume were increased compared with that before surgery, and AHI and SaO2 were improved compared with that before surgery. Conclusion This study suggests that it is feasible for patients with OSAHS who are unable to tolerate or unwilling to undergo noninvasive assisted ventilation to undergo simultaneous surgery for multiplane stenosis. It can reduce clinical symptoms and improve cardiopulmonary function.

The effectiveness of functional electrical stimulation of the legs in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials

Objective To investigate the effectiveness of functional electrical stimulation of the legs in patients with heart failure. Methods Data were obtained from PubMed, Cochrane Library, and Embase databases until August 12, 2021. We included randomized controlled trials that evaluated the effects of functional electrical stimulation applied to the legs of patients with heart failure, namely changes in cardiopulmonary function, muscle strength, and quality of life. Results In total, 14 randomized controlled trials (consisting of 518 patients) were included in our article. Pooled estimates demonstrated that functional electrical stimulation significantly improved peak oxygen consumption (peak VO2; standardized mean difference = 0.33, 95% confidence interval = 0.07–0.59, eight randomized controlled trials, n = 321), 6-min walking distance (mean difference = 48.03 m, 95% confidence interval = 28.50–67.57 m, 10 randomized controlled trials, n = 380), and Minnesota Living with Heart Failure Questionnaire quality of life score (mean difference = − 8.23, 95% confidence interval = − 12.64 to − 3.83, nine randomized controlled trials, n = 383). Muscle strength of lower extremities was not significantly improved in the functional electrical stimulation group compared with that in the control group (standardized mean difference = 0.26, 95% confidence interval = − 0.18 to 0.71, five randomized controlled trials, n = 218). Furthermore, the subgroup analysis revealed that functional electrical stimulation significantly improved peak VO2, 6-min walking distance, and Minnesota Living with Heart Failure Questionnaire quality of life score in the heart failure with reduced ejection fraction and heart failure with preserved ejection fraction subgroups. Conclusion Functional electrical stimulation can effectively improve the cardiopulmonary function and quality of life in patients with heart failure. However, functional electrical stimulation did not significantly improve muscle strength in the legs.

Abstract 9677: Therapeutic Improvements in Pulmonary Arterial Hypertension Are Related to Cardiopulmonary Function but Not Skeletal Muscle Oxygen Extraction

Introduction: World Symposium Group 1 pulmonary arterial hypertension (PAH) patients have impaired function from both central oxygen delivery and skeletal muscle oxygen extraction. The effect of PH-directed therapy on skeletal muscle oxygen extraction is unknown. The aim of this study is to determine if therapy associated changes in muscle extraction parallel changes in cardiopulmonary function. Methods: Retrospective analysis was performed on twenty-nine PAH patients (24 female, mean age 54±11.4 years) receiving prostacyclin therapy (18 on monotherapy). Subjects underwent invasive cardiopulmonary exercise testing (iCPET) for treatment response evaluation followed by repeat surveillance iCPET with mean follow-up of 10.4±5.2 months. Skeletal muscle oxygen extraction was quantified by arterio-venous difference indexed to hemoglobin (Ca-vO 2 /Hgb) and systemic oxygen extraction ratio (SER) (Ca-vO 2 /CaO 2 ). Central oxygen delivery (DO 2 ) was calculated as peak cardiac output X CaO2 at peak exercise. Functional capacity was semi-quantified by six-minute walk test (6MWT) distances between assessments (n=20). Subjects were stratified into two groups: those with improvement (n=10) vs unimproved (n=19) in currently accepted ERS/COMPERA score ( Figure ). Results: Improvements in ERS/COMPERA score were related to DO 2 (318.3±273.1 vs -38.3±684.9 mL/min, P=.016 ) and PVR (-4.8±3.0 vs -0.6±3.2 WU, P=.002 ) (Figure A &amp; B). However, there was not a detectible difference between assessments in Ca-vO 2 /hgb (-0.01±0.14 vs 0.00±0.27 mL/g, P=.573 ), SER (-0.01±0.10 vs 0.00±0.20, P=.573 ), or 6MWT (7 improved, 13 unimproved) (77±115 vs 25±104 meters, P=.877 ) ( Figure C &amp; D ). Conclusions: Although PH-directed therapy improves both PVR and oxygen delivery, its effects on skeletal muscle extraction are questionable. Clinicians should consider that oxygen extraction may influence functional capacity when evaluating therapeutic improvement.

Effects of Stress Psychological Intervention on the Cardiopulmonary Function, Negative Emotion, Self-Efficacy, and Quality of Life in Patients with Acute Respiratory Failure.

Objective To investigate the changes in cardiopulmonary function, negative emotion, self-efficacy, and quality of life in patients with acute respiratory failure (ARF) after stress psychological intervention. Methods A prospective study was conducted on 104 patients with ARF admitted to our hospital from March 2019 to March 2021. According to the random number method, the patients were divided into a control group (n = 52) and an experimental group (n = 52). Routine intervention was implemented in the control group, and stress psychological intervention was implemented in the experimental group on the basis of the control group. The cardiopulmonary function, negative emotion, self-efficacy, and quality of life in the two groups were compared. Results The left ventricular ejection fractions and fraction shortening in the experimental group were higher than those in the control group, as well as the left ventricular mass index was lower than that in the control group (P < 0.05). The first forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC in the experimental group were higher than those in the control group (P < 0.05). The Self-Rating Anxiety Scale scores and Self-Rating Depression Scale scores in the experimental group were lower than those in the control group (P < 0.05). The General Self-Efficacy Scale scores of the experimental group were higher than those of the control group (P < 0.05). The Concise Health Measurement Scale scores of the experimental group were higher than those of the control group (P < 0.05). Conclusion Stress psychological intervention in patients with ARF can improve cardiopulmonary function, reduce negative emotions, improve self-efficacy, and improve quality of life.

SIMULATION OF THE RELATIONSHIP BETWEEN EXERCISE AND CARDIOPULMONARY FUNCTION AT HIGH ALTITUDE

ABSTRACT Introduction: Due to various uncertain and unexpected factors in life such as diseases, natural disasters, traffic accidents, and congenital disabilities, the number and proportion of lower limb amputations are still rising for many reasons, so the research on lower limb prostheses is particularly important. Objective: This work aimed to study the relationship between altitude exercise and cardiopulmonary function. Methods: A model of abnormal changes in cardiopulmonary function was established, and then 40 plateau exercisers were selected, all of whom arrived in Tibet in March 2017. The relationship between pulmonary circulation volume and internal pressure in the chest was observed and compared. The relationship between cardiopulmonary sensory reflex and exercise (high altitude) breathing and heart rate was analyzed. A comparison of the cardiopulmonary function of subjects of different genders was implemented. Moreover, the influence of different altitudes on the subjects’ cardiopulmonary function and the subjects’ cardiopulmonary function changes before departure and during the first, second, and third week after departure were observed and compared. Results: I. As the pressure in the thoracic cavity increased, the subjects’ pulmonary circulation blood volume gradually decreased, and the decrease was most obvious in the stage of thoracic pressure −50 to 0. II. As the cardiorespiratory reflex coefficient increased, the subjects’ breathing and heart rate compensatory acceleration appeared. III. Tracking and monitoring of the subjects’ cardiopulmonary indicators revealed that with the increase in altitude, the subjects’ average arterial pressure, respiratory frequency, and heart rate all showed an upward trend, while the blood oxygen saturation value showed a downward trend. IV. No matter how high the altitude was, the average arterial pressure, respiratory rate, and heart rate monitored of the subjects under exercise were significantly superior to the indicator values under resting state. In contrast, the blood oxygen saturation value showed the opposite trend. V. The subjects’ average arterial pressure, respiration, and heart rate in the first week were higher than other periods, but the blood oxygen saturation was relatively lower. In the second and third weeks, the changes in cardiopulmonary function were relatively smooth (all P&lt;0.05). VI. The changes in the index of the cardiopulmonary function of subjects of different genders were small (p&gt;0.05). Conclusion: Through modeling, the results of the plateau environment on the cardiopulmonary function of the body were made clearer, and these research data provided theoretical references for the training of the sports field in the plateau area. Level of evidence II; Therapeutic studies - investigation of treatment results.

Temporal changes in pulmonary gas exchange efficiency when breath-hold diving below residual volume.

What is the central question of this study? How does deep breath-hold diving impact cardiopulmonary function, both acutely and over the subsequent 2.5hours post-dive? What is the main finding and its importance? Breath-hold diving, to depths below residual volume, is associated with acute impairments in pulmonary gas exchange, which typically resolve within 2.5hours. These data provide new insight into the behaviour of the lungs and pulmonary vasculature following deep diving. Breath-hold diving involves highly integrative and extreme physiological responses to both exercise and asphyxia during progressive elevations in hydrostatic pressure. Over two diving training camps (Study 1 and 2), 25 breath-hold divers (recreational to world-champion) performed 66 dives to 57±20m (range: 18-117m). Using the deepest dive from each diver, temporal changes in cardiopulmonary function were assessed using non-invasive pulmonary gas exchange (indexed via the O2 deficit), ultrasound B-line scores, lung compliance and pulmonary haemodynamics at baseline and following the dive. Hydrostatically induced lung compression was quantified in Study 2, using spirometry and lung volume measurement, enabling each dive to be categorized by its residual volume (RV)-equivalent depth. From both studies, pulmonary gas exchange inefficiency - defined as an increase in O2 deficit - was related to the depth of the dive (r2 =0.345; P<0.001), with dives associated with lung squeeze symptoms exhibiting the greatest deficits. In Study 1, although B-lines doubled from baseline (P=0.027), cardiac output and pulmonary artery systolic pressure were unchanged post-dive. In Study 2, dives with lung compression to ≤RV had higher O2 deficits at 9min, compared to dives that did not exceed RV (24±25 vs. 5±8mmHg; P=0.021). The physiological significance of a small increase in estimated lung compliance post-dive (via decreased and increased/unaltered airway resistance and reactance, respectively) remains equivocal. Following deep dives, the current study highlights an integrated link between hydrostatically induced lung compression and transient impairments in pulmonary gas exchange efficiency.

ASSET: Alternative schedule sunitinib in metastatic renal cell carcinoma (RCC)—Cardiopulmonary exercise testing (CPET).

300 Background: Sunitinib (SUN) is a vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) approved for treatment of advanced RCC and high risk RCC after nephrectomy. Evidence suggests that a 2 week (wk) on, 1 wk off schedule (2/1) of SUN administration may be more tolerable than the standard 4 wk on, 2 wk off schedule (4/2). We investigated changes in cardiopulmonary function and related parameters over time in RCC patients treated with both schedules of SUN. Methods: Patients starting SUN for RCC, with KPS ≥80 and normal organ and marrow function, were enrolled and randomized 1:1 to schedule 4/2 or 2/1. Subjects were required to be able to walk and jog on a treadmill and to complete an acceptable CPET at baseline (BL). Primary endpoint was change in peak oxygen uptake (VO2peak) on both schedules at 12 wk from BL. Key secondary endpoints were change from BL to 12 wk in: left ventricular ejection fraction (LVEF), upper and lower body strength (1-RM), functional measures (chair stand, timed up-and-go [TUG], 6-minute walk test [6MWT], quality of life (QOL; FACT-Fatigue, FKSI-19), anxiety and depression (HADS) and exercise behavior (Godin Leisure Score). ANCOVA models controlling for baseline values were used to analyze the primary and secondary endpoints. Results: Between 11/20/2017 and 6/24/2019, 9 out of a planned 30 patients consented to participate at Duke. Two patients declined to participate and 7 patients were enrolled on study: 4 on Arm A and 3 on Arm B. All 7 patients completed the 12 wk study. Median age, BMI, and VO2peak were 65 yrs, 30.5 kg/m2, and 19.2 ml kg−1 min−1. We observed no difference in the primary endpoint of VO2peak between arms (p=0.84). We report BL to 12 wk change scores for all patients starting SUN (Table). In addition, mean change scores (SE) for QOL by FACIT-Fatigue and FKSI-19 were -2.88 (1.5) and 1.2 [9.8]; anxiety and depression by HADS 1.14 (1.3); and physical activity 1.14 (1.7). Conclusions: We observed non-significant declines in most measures of physical fitness and function during the first 12 wk of treatment with SUN. To our knowledge, this is the first reported study of these parameters in patients with RCC. Given that a VEGF TKI, alone and with an immune checkpoint inhibitor, remains a standard of care for metastatic ccRCC, studies should be undertaken to examine whether exercise training can prevent declines in physical fitness and function. Clinical trial information: NCT03109015 . [Table: see text]

Health effects of occupational exposure to printer emissions on workers in China: Cardiopulmonary function change

Printers emitted nanoparticles (NPs), ozone (O3) and volatile organic chemicals (VOCs) during operation that elicited adverse effects on indoor air quality of the printing room, which may affect the health of exposed workers. The aim of this work was to explore the health effects of occupational exposure to printer emissions on workers, especially cardiovascular and lung function. We sampled particles in the print shop for characterization, including particle size distribution and elemental composition, and measured PM1 number concentrations in print shops and other workplaces. We assessed blood pressure, heart rate and pulmonary function in 53 printing room workers and 54 controls in Beijing, China. Multiple linear regression analysis were used to examine health effects of exposure to printer emissions. The PM1 number concentration in the print shop was more than 2 times that of the control group. Compared with controls, the exposed workers with lower education and income had heavier workload with a median of 7 days per week and 12 h per day on working days, and presented cardiopulmonary function injury with increased the diastolic blood pressure (DBP), systolic blood pressure (SBP), and mean arterial pressure (MAP). The most significant changes of cardiopulmonary function were found in exposed workers with more than 10 years of working age. Multiple linear regression also showed printer emissions exposure was associated with increased SBP and MAP, while decreased lung function indices. This study found changes in the cardiopulmonary function of staff members exposed to printer emissions, which prompted the necessity and urgency of improving the environment of printing rooms and protecting the health of exposed workers.

Impact of surgical treatment of pectus carinatum on cardiopulmonary function: a prospective study.

OBJECTIVESThe frequency of sternochondroplasty in cases of pectus carinatum (PC) has increased due to greater surgeon experience and modified surgical techniques. PC deformity does not usually cause cardiopulmonary malfunction or impairment. However, whether cardiopulmonary function changes after surgical repair remains a matter of controversy. The aim of our prospective study was to determine if surgery changes preoperative cardiopulmonary function.METHODSNineteen patients (16 males, 3 females) were enrolled in a prospective, open-label, single-arm, single-centre clinical trial (Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Function) (NCT02163265) between July 2013 and January 2017. All patients underwent PC repair via a modified Ravitch procedure and wore a lightweight, patient-controlled chest brace for 8 weeks postoperatively (the Innsbruck protocol). The average follow-up surgical examination was 8.3 months after surgery. In all enrolled patients, before surgery and not before 6 months postoperatively chest X-ray, 3-dimensional volume-rendered computed tomography thorax imaging, cardiopulmonary function tests with stepwise cycle spiroergometry (sitting and supine position) and Doppler echocardiography were performed; questionnaires about daily physical activity were also completed.RESULTSFourteen patients (aged 16.3 ± 2.6 years at study entry) completed the study. Changes in submaximal and peak power output were not detected during sitting, or when in the supine position. Also, no clinically relevant postoperative changes in spirometry or echocardiography were noted.CONCLUSIONSOur findings confirm that surgical correction of PC does not impair cardiopulmonary function at rest or during physical exercise.Clinical registration numberclinicaltrials.gov NCT02163265.

Exposure to air pollution is associated with adverse cardiopulmonary health effects in international travellers.

With the number of annual global travellers reaching 1.2 billion, many individuals encounter greater levels of air pollution when they travel abroad to megacities around the world. This study's objective was to determine if visits to cities abroad with greater levels of air pollution adversely impact cardiopulmonary health. A total of 34 non-smoking healthy adult participants who travelled abroad to selected cities from the New York City (NYC) metropolitan area were pre-trained to measure lung function, blood pressure and heart rate (HR)/HR variability (HRV) and record symptoms before, during and after travelling abroad. Outdoor particulate matter (PM)2.5 concentrations were obtained from central monitors in each city. Associations between PM exposure concentrations and cardiopulmonary health endpoints were analysed using a mixed effects statistical design. East and South Asian cities had significantly higher PM2.5 concentrations compared with pre-travel NYC PM2.5 levels, with maximum concentrations reaching 503μg/m3. PM exposure-related associations for lung function were statistically significant and strongest between evening Forced Expiratory Volume in the first second (FEV1) and same-day morning PM2.5 concentrations; a 10-μg/m3 increase in outdoor PM2.5 was associated with a mean decrease of 7mL. Travel to a highly polluted city (PM2.5 > 100μg/m3) was associated with a 209-ml reduction in evening FEV1 compared with a low polluted city (PM2.5 < 35μg/m3). In general, participants who travelled to East and South Asian cities experienced increased respiratory symptoms/scores and changes in HR and HRV. Exposure to increased levels of PM2.5 in cities abroad caused small but statistically significant acute changes in cardiopulmonary function and respiratory symptoms in healthy young adults. These data suggest that travel-related exposure to increased PM2.5 adversely impacts cardiopulmonary health, which may be particularly important for travellers with pre-existing respiratory or cardiac disease.

Increased cardiorespiratory fitness and skeletal muscle size following single-leg knee extension exercise training.

It is unclear to what extent an improved skeletal muscle phenotype influences maximal aerobic capacity (VO2max) when changes in cardiopulmonary function are limited. Thus, to primarily target skeletal muscle adaptations, we employed an alternating single-leg knee extension exercise training protocol and evaluated the impact on skeletal muscle morphology and whole-body exercise capacity. Eight sedentary volunteers (20±1 years; VO2max: 38.4±2.6 mL/kg/min) completed 12 weeks of progressive alternating single-leg training. Subjects performed a bilateral maximal graded exercise test on a cycle ergometer, a single-leg peak workload test on a knee extensor ergometer, knee extension muscle function testing, and a dual energy X-ray absorptiometry scan before and after training. Skeletal muscle biopsies were obtained before and after the training protocol to assess muscle fiber type, by determining myosin heavy chain isoform composition using gel electrophoresis, and fiber size using immunofluorescent staining of muscle cross sections. Following training there were increases (P<0.05) in VO2max (2.53±0.25 vs. 2.76±0.20 L/min; 9±3%), the VO2 at ventilatory threshold (1.88±0.19 vs. 2.01±0.18 L/min; 8±2%), peak two-leg cycling workload (183±17 vs. 206±19 W; 13±2%), single-leg peak workload (40.0±4.4 vs. 55.3±5.1 W; 43±8%), skeletal muscle lean mass (3±1%), citrate synthase protein content (44±20%), as well as slow and fast myofiber size (13±4% and 14±4%, respectively) while there was a decrease (P<0.05) in hybrid fiber content (-33±8%). These data suggest that inducing a more oxidative phenotype in skeletal muscle with isolated aerobic exercise training improves cardiopulmonary responses to maximal exercise. Additionally, the low cardiovascular burden associated with isolated single-leg exercise may be a useful training approach for clinical populations with skeletal muscle dysfunction or cardiovascular limitations to exercise.

Stage‑dependent changes of β2‑adrenergic receptor signaling in right ventricular remodeling in monocrotaline‑induced pulmonary arterial hypertension.

Right ventricular (RV) remodeling coupled with extensive apoptosis in response to unrestrained biomechanical stress may lead to RV failure (RVF), which is the immediate cause of death in the majority of patients with pulmonary arterial hypertension (PAH). Overexpression of β2-adrenergic receptor (β2-AR) signaling has been reported to induce myocardiotoxicity in patients with left heart failure. However, the role of β2-AR signaling in the pathophysiology of PAH development has remained elusive. To address this issue, the present study investigated the changes in cardiopulmonary function and structure, as well as the expression of regulators of fibrosis and apoptosis in RVF following monocrotaline (MCT; 60 mg/kg, i.p.)-induced PAH in rats. Cardiopulmonary function and structure, remodeling and apoptosis, as well as G protein-coupled receptor (GPCR) and β2-AR signaling, were documented over a period of 6 weeks. In the early stages, elevated pulmonary arterial pressure, pulmonary lesions, RV hypertrophy, evidence of left ventricular (LV) hyperfunction and accelerated heart rate were observed in animals with MCT-induced PAH. The levels of angiotensin II receptor type 1b (Agtr1b), Agtr2 and Agt were markedly upregulated and the expression of β2-AR phospho-Ser(355,356) steadily decreased in the right heart. As the disease progressed, LV dysfunction was observed, as evidenced by decreased LV systolic pressure and increased LV end-diastolic pressure, which was accompanied by a sustained increase in circulating brain natriuretic peptide levels. Of note, increased levels of cardiomyocyte apoptosis and concomitant RV remodeling, including hypertrophy, dilatation, inflammation and fibrosis, were observed, despite the enhanced RV contractility. Furthermore, alterations in GPCR signaling and activation in β2-AR-Gs-protein kinase A/Ca2+/calmodulin-dependent kinase II signaling were observed in the late stages of PAH. These results suggested that treatment with MCT results in adaptive and maladaptive RV remodeling and apoptosis during the progression of PAH, which is accompanied by distinct changes in the β2-AR signaling. Therefore, these results enable researchers to better understand of pathophysiology of MCT-induced PAH, as well as to determine the effects of novel therapies.

The effect on cardiopulmonary function after thoracoplasty in pectus carinatum: a systematic literature review.

Creating an aesthetically appealing result using thoracoplasty, especially when correcting extensive deformities, but only causing low morbidity, is challenging. The frequency of thoracoplasties in cases of pectus carinatum (PC) has increased due to improved experience and modified surgical techniques, resulting in low morbidity and low complication rates. The indications for surgical treatment are still controversial and, in most cases, remain aesthetic or psychological rather than physiological. However, whether cardiopulmonary function changes after surgical repair remains a matter of controversy. We sought to investigate and shed light on published knowledge regarding this question. We searched MEDLINE and PubMed databases, using various defined search phrases and inclusion criteria, to identify articles on pre- and postoperative cardiopulmonary evaluation and outcomes. Six studies met the inclusion criteria: 5 studies evaluated patients with PC for cardiopulmonary outcomes after chest wall surgery and 1 did so following conservative compression treatment. In these studies, surgical and conservative correction of PC did not reduce absolute lung volumes and spirometric measurements and consequently had no pathogenic effect on cardiopulmonary function. The results of this systematic review suggest that surgical correction of PC has no symptomatic pathogenic effect on cardiopulmonary function. The results, however, revealed both heterogeneity in the examinations used and inconsistent methods within each study. Further prospective trials with a stronger methodological design are necessary to objectively confirm that surgical correction of PC does not impair cardiopulmonary function.

Changes in cardiopulmonary function according to posture during recovery after maximal exercise.

[Purpose] This study was undertaken to measure cardiopulmonary function according to body position during the recovery period after maximal exercise and to identify an effective position after high-intensity exercise. [Subjects and Methods] Fifteen male university students in their twenties participated in the study. The subjects were randomly assigned to the supine position, the sitting position, or the trunk forward leaning position during the recovery period following maximal exercise. Oxygen uptake, minute ventilation volume, respiration rate, and heart rate according to posture were measured in a stable state, at maximal exercise loading, and at 1, 3, and 5 minutes after maximal exercise. [Results] Changes of cardiopulmonary function according to posture during the recovery period after maximal exercise showed that minute ventilation volume was smaller in the trunk forward leaning position than in the sitting or supine positions, and oxygen uptake also declined. [Conclusion] The trunk forward leaning position has a more positive effect on pulmonary ventilation after high-intensity exercise.