Decline In Functional Capacity Research Articles

The AccelerAge framework: a new statistical approach to predict biological age based on time-to-event data.

Aging is a multifaceted and intricate physiological process characterized by a gradual decline in functional capacity, leading to increased susceptibility to diseases and mortality. While chronological age serves as a strong risk factor for age-related health conditions, considerable heterogeneity exists in the aging trajectories of individuals, suggesting that biological age may provide a more nuanced understanding of the aging process. However, the concept of biological age lacks a clear operationalization, leading to the development of various biological age predictors without a solid statistical foundation. This paper addresses these limitations by proposing a comprehensive operationalization of biological age, introducing the "AccelerAge" framework for predicting biological age, and introducing previously underutilized evaluation measures for assessing the performance of biological age predictors. The AccelerAge framework, based on Accelerated Failure Time (AFT) models, directly models the effect of candidate predictors of aging on an individual's survival time, aligning with the prevalent metaphor of aging as a clock. We compare predictors based on the AccelerAge framework to a predictor based on the GrimAge predictor, which is considered one of the best-performing biological age predictors, using simulated data as well as data from the UK Biobank and the Leiden Longevity Study. Our approach seeks to establish a robust statistical foundation for biological age clocks, enabling a more accurate and interpretable assessment of an individual's aging status.

Heterogeneous Association of Tooth Loss with Functional Limitations

Tooth loss is prevalent in older adults and associated with functional capacity decline. Studies on the susceptibility of some individuals to the effects of tooth loss are lacking. This study aimed to investigate the heterogeneity of the association between tooth loss and higher-level functional capacity in older Japanese individuals employing a machine learning approach. This is a prospective cohort study using the data of adults aged ≥65 y in Japan (N = 16,553). Higher-level functional capacity, comprising instrumental independence, intellectual activity, and social role, was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The scale ranged from 0 (lowest function) to 13 (highest function). Doubly robust targeted maximum likelihood estimation was used to estimate the population-average association between tooth loss (having <20 natural teeth) and TMIG-IC total score after 6 y. The heterogeneity of the association was evaluated by estimating conditional average treatment effects (CATEs) using the causal forest algorithm. The result showed that tooth loss was statistically significantly associated with lower TMIG-IC total scores (population-average effect: −0.14; 95% confidence interval, −0.18 to −0.09). The causal forest analysis revealed the heterogeneous associations between tooth loss and lower TMIG-IC total score after 6 y (median of estimated CATEs = −0.13; interquartile range = 0.12). The high-impact subgroup (i.e., individuals with estimated CATEs of the bottom 10%) were significantly more likely to be older and male, had a lower socioeconomic status, did not have a partner, and had poor health conditions compared with the low-impact subgroup (i.e., individuals with estimated CATEs of the top 10%). This study found that heterogeneity exists in the association between tooth loss and lower scores on functional capacity. Implementing tooth loss prevention policy and clinical measures, especially among vulnerable subpopulations significantly affected by tooth loss, may reduce its burden more effectively.

Promoting Return to Work After Vocational Rehabilitation Using a Work-Related Fitness App: Protocol for a Cluster-Randomized Controlled Trial.

Retraining programs in vocational rehabilitation are often characterized by a low level of physical activity, even when targeting jobs with primarily physical demands. They might therefore be accompanied by a decline in functional capacity if the lack of physical activity is not compensated by increased activity during leisure time. The implementation of a work-related exercise app might be a promising approach to promoting a return to work in vocational rehabilitation. We developed the "WORKout-app" which provides exercise plans based on a comparison of the physical demands of the retraining profession and the current functional capacity. The aim of this study is to examine the effects of app-based exercise during vocational rehabilitation on perceived work ability (primary outcome), occupational self-efficacy, days of sick leave, and return to work (secondary outcomes). We conducted a cluster-randomized controlled trial with 2 arms (intervention: WORKout-app vs control: treatment as usual) in 4 cohorts of 5 vocational rehabilitation centers in Germany. Participants are nested within retraining classes per vocational rehabilitation center and per cohort assigned to either the intervention condition or the control condition. The target sample size at the participant level is 598. Measurement time points include baseline, the end of rehabilitation, 3 months after the end of rehabilitation, and 6 months after the end of rehabilitation. Linear and generalized linear mixed-effects models are performed to test for treatment differences in outcomes. This study is funded by the German Federal Pension Insurance. The trial is registered with the German Clinical Trials Register (DRKS00030775) and approved by the Ethics Committee of the German Sport University Cologne (145/2022). The findings of the study will inform researchers and practitioners about the effectiveness of an exercise app developed to counteract the effects of physical inactivity during vocational rehabilitation. DERR1-10.2196/50200.

A protocol for remote collection of skeletal muscle mass via D3-creatine dilution in community-dwelling postmenopausal women from the Women's Health Initiative.

There is emerging evidence that cancer and its treatments may accelerate the normal aging process, increasing the magnitude and rate of decline in functional capacity. This accelerated aging process is hypothesized to hasten the occurrence of common adverse age-related outcomes in cancer survivors, including loss of muscle mass and decrease in physical function. However, there is no data describing age-related loss of muscle mass and its relation to physical function in the long-term in cancer survivors. This study protocol describes the use of a novel method of muscle mass measurement, D3-creatine dilution method (D3Cr), in a large sample (n~6000) of community dwelling postmenopausal women from the Women's Health Initiative (WHI). D3Cr will be used to obtain a direct measure of muscle mass remotely. Participants will be drawn from two sub-cohorts embedded within the WHI that have recently completed an in-home visit. Cancer survivors will be drawn from the Life and Longevity After Cancer (LILAC) cohort, and cancer-free controls will be drawn from the WHI Long Life Study 2. The overall objective of this study is to examine the antecedents and consequences of low muscle mass in cancer survivors. The study aims are to: 1) create age-standardized muscle mass percentile curves and z-scores to characterize the distribution of D3- muscle mass in cancer survivors and non-cancer controls, 2) compare muscle mass, physical function, and functional decline in cancer survivors and non- cancer controls, and 3) use machine learning approaches to generate multivariate risk-prediction algorithms to detect low muscle mass. The D3Cr method will transform our ability to measure muscle mass in large-scale epidemiologic research. This study is an opportunity to advance our understanding of a key source of morbidity among older and long-term female cancer survivors. This project will fill knowledge gaps, including the antecedents and consequences of low muscle mass, and use innovative methods to overcome common sources of bias in cancer research. The results of this study will be used to develop interventions to mitigate the harmful effects of low muscle mass in older adults and promote healthy survivorship in cancer survivors in the old (>65) and oldest-old (>85) age groups.

Overview of Innate Immune Cell Landscape in Liver Aging.

Aging is a biological process with a gradual decline in functional capacity, and this process often enhances the risk of chronic disease morbidity and mortality. With advanced age, the immune system undergoes a process of remodeling that can lead to a chronic inflammatory state, termed immunosenescence and inflammaging, respectively. Immunosenescence is accompanied by changes in the number, proportion, and functional capacity of the innate immune cells. The accumulation of dysfunctional immune cells and the presence of low-grade inflammation can lead to organ damage and expedite the aging process. The liver, crucial in regulating the body's metabolism and immune function, is not exempt from these effects. Age-related modifications affect its immune function and regenerative abilities, potentially increasing the prevalence of age-related liver diseases. While aging's impact on the liver is relatively less severe compared to other organ systems, it still experiences an infiltration of innate immune cells and heightened inflammation levels. This review will elaborate on how aging affects the liver's innate immune cells, such as neutrophils, macrophages, dendritic cells, mast cells, and innate lymphoid cells. It will also explore potential strategies for delaying immunosenescence to alleviate these age-related changes.

Is prehospital physical performance a predictor of functional capacity decline at discharge in hospitalized Brazilian older adults?

BackgroundHospitalization contributes to functional decline in older adults. ObjectiveTo assess the relationship between physical performance on admission and functional capacity and functional capacity decline at discharge, and to investigate tools capable of predicting this decline. MethodsProspective longitudinal study with 75 older adults admitted to a public hospital between July 2021 and February 2022. The independent variable was physical performance evaluated on admission by handgrip strength (HGS) and the Short Physical Performance Battery (SPPB). The dependent variables were functional capacity for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) and their decline between admission and discharge. Statistical analyses were performed using linear and logistic regression and ROC curves. ResultsThe median time between admission and participant assessment was 1 day (IQR=1–2 days). Median hospitalization time was 18 days (IQR= 7.5–30 days). Functional capacity for BADLs and IADLs declined in 39% and 79% of the participants, respectively. Performance in HGS and the SPPB at baseline, in adjusted models, explained 29.3 to 35.3% of functional capacity at discharge. One additional point in the SPPB decreased the risk of functional capacity decline for BADLs by 20.9% (OR=0.79, 95% CI: 0.68, 0.91). The AUC values for the SPPB (AUC=0.67) and HGS (AUC=0.65) were significant in identifying functional decline for BADLs, but not IADLs. ConclusionIn Brazilian older adults, physical performance on admission was related to functional capacity and its decline at discharge. Physical performance on admission is predictive of functional decline at discharge.

Validation and reliability of the test of daily Activities-GLITTRE (GLITTRE-ADL TEST) to evaluate functional capacity in older adults

Introduction: The decline in functional capacity (FC) interferes with the functional independence of older adults, so it is important to assess the FC and use appropriate instruments for this. Objective: To investigate the Glittre Activities of Daily Living (ADL) test’s validity and reliability for assessing functional capacity in older adults. Methods: Cross-sectional study with a sample of 100 elderly (68 ± 5.16 years). To assess the convergent validity, the Six-Minute Walk Test (6MWT) and the Timed Up and Go Test (TUG) were performed. The intra-examiner test-retest of the Glittre-ADL test was performed on the same day with a 30-minute interval between repetitions and inter-examiner reliability with an interval of seven days. Results: There was a strong correlation between the Glittre-ADL test and the 6MWT (r= -0.75; p&lt;0.001) and the TUG (r=0.77; p&lt;0.001). The intra-examiner and inter-examiner reliability was excellent (ICC)=0.91 and 95% CI=0.14-0.97; p&lt;0.001 and ICC=0.91; 95% CI: 0.86-0.94; p&lt;0.001, respectively). Conclusion: The Glittre-ADL test demonstrated that it is valid and that its reliability is adequate to assess functional capacity in older adults.

Proteomic characterization of aging-driven changes in the mouse brain by co-expression network analysis

Brain aging causes a progressive decline in functional capacity and is a strong risk factor for dementias such as Alzheimer’s disease. To characterize age-related proteomic changes in the brain, we used quantitative proteomics to examine brain tissues, cortex and hippocampus, of mice at three age points (3, 15, and 24 months old), and quantified more than 7000 proteins in total with high reproducibility. We found that many of the proteins upregulated with age were extracellular proteins, such as extracellular matrix proteins and secreted proteins, associated with glial cells. On the other hand, many of the significantly downregulated proteins were associated with synapses, particularly postsynaptic density, specifically in the cortex but not in the hippocampus. Our datasets will be helpful as resources for understanding the molecular basis of brain aging.

YAŞLILIK TEORİLERİ ÇERÇEVESİNDE AKTİF YAŞLANMAYI DESTEKLEYEN MEKÂNSAL DÜZENLEMELER

Rapid ageing all over the world is changing the population rates and social structure of the society. The change causes some structural transformations in family structures and social life as well as demographic structures of countries. The subject has been handled by experts in many aspects and theories and approaches to old age have been produced. The 'decline in functional capacity', which starts to decrease as the individual gets older, is the remarkable problem of old age. Social, environmental and economic factors, as well as physical factors, affect the lives of the older persons, and the 'capacity range for maintaining function', which is high in adulthood, opens with old age, thus 'functional capacity' decreases. "Active ageing", which is one of the theories of ageing, reveals the increase in physical limitations/inadequacies as ageing individuals get older because they do not have a homogenous group. The approach also emphasises the 'capacity of the urban environment to support active ageing' in order to enable a healthy and active life course. Through the study, which is produced from the author's doctoral thesis, it is aimed to reveal the contributions of arrangements such as universal design and accessibility that support active ageing to a more livable urban physical environment and social life.

Sex Differences in Quality of Life in Patients with Ischemia with No Obstructive Coronary Artery Disease (INOCA): A Patient Self-Report Retrospective Survey from INOCA International.

Women with obstructive coronary artery disease (CAD) have a relatively lower quality of life (QoL) compared to men, but our understanding of sex differences in QoL in ischemia with no obstructive coronary artery disease (INOCA) is limited. We conducted a survey of patient members of INOCA International with an assessment of self-reported health measures. Functional capacity was retrospectively estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed before and after INOCA symptom onset. Of the 1579 patient members, the overall survey completion rate was 21%. Women represented 91% of the respondents. Estimated functional capacity, expressed as metabolic equivalents (METs), was higher before compared to after INOCA diagnosis comparably for both women and men. For every one MET decline in functional capacity, there was a significantly greater decline in QoL for men compared with women in physical health (4.0 ± 1.1 vs. 2.9 ± 0.3 days/month, p < 0.001), mental health (2.4 ± 1.2 vs. 1.8 ± 0.3 days/month, p = 0.001), and social health/recreational activities (4.1 ± 1.0 vs. 2.9 ± 0.3 days/month, p = 0.0001), respectively. In an international survey of patients living with INOCA, despite similar diagnoses, clinical comorbidities, and symptoms, INOCA-related functional capacity declines are associated with a greater adverse impact on QoL in men compared to women.

Ways to predict interstitial lung disease in patients with systemic sclerosis: results of an observational study

In patients with systemic sclerosis (SSc), interstitial lung disease (ILD) is a factor in the decline of functional capacity up to disability and is also the leading cause of death. Therefore, one of the most important tasks in the treatment of this group of patients is not only to detect involvement of respiratory system, but also to predict the likelihood of its development.Objective: to study the possibility of predicting the development of ILD and advanced ILD in patients with SSc.Material and methods. The study included 79 patients with SSc (mean age 64.4±11.5 years; 94.9% women) from the Registry of myositis, SSc and Mixed Connective Tissue Diseases (РЕМИССиС) who underwent high-resolution computed tomography (HRCT) of the lungs. Classification trees (CTr) were constructed to predict the development of widespread ILD using the CHAID algorithm (exhaustive). All patients were tested for antibodies against Scl-70 (anti-Scl-70), CENP-B (anti-CENP-B), and PmScl (anti-PmScl).Results and discussion. ILD signs according to HRCT were detected in 53 patients. Fibrotic (34.2%) and cellular (15.2%) types of nonspecific interstitial pneumonia were the most common, and common interstitial pneumonia was less frequent (11.4%).The presence of ILD and advanced ILD (involvement of more than 20% of the lung parenchyma) were significantly associated with the detection of any autoantibodies, except anti-centromere antibodies, an increase in pulmonary artery systolic pressure, a decrease in forced vital capacity, diffusing capacity of the lungs, blood oxygen saturation at rest, and all parameters of six-minute walk test (6MWT), and complaints of shortness of breath. In addition, the presence of extensive ILD was also significantly associated with diffuse SSc and with SSc without skin manifestations.In establishing the CTr, it was found that the development of widespread ILD was unlikely in individuals who were able to walk more than 440 m in 6MWT and had neither anti-Scl-70 nor anti-PmScl.Significant associations were also found between the radiological pattern of ILD and the types of disease-specific antibodies.Conclusion. The 6MWT data in conjunction with the results of testing for SSc-specific autoantibodies provide a very accurate prediction of the presence and extent of ILD. It is advisable to include these indicators in the algorithm for screening and monitoring patients with SSc.

Factors Related to Functional Capacity Deterioration in Surgical Lung Cancer Patients: A Systematic Review.

A decline in functional capacity is anticipated after lung resection. However, the factors related to functional capacity deterioration in surgical lung cancer patients have not been systematically reviewed. To investigate the factors related to functional capacity deterioration and the trajectory of functional capacity after lung cancer surgery. PubMed, CINAHL, Scopus, and SPORTDiscus were searched between January 2010 and July 2022. Two reviewers conducted a critical appraisal of individual sources. Twenty-one studies met the inclusion criteria. This review presents evidence for risk factors related to functional capacity deterioration after lung cancer surgery, including patient characteristics (age), preoperative clinical factors (vital capacity, quadriceps force, B-type natriuretic peptide level), surgery-related factors (surgical procedure, duration of chest tube drainage, postoperative complications), and postoperative clinical factor (C-reactive protein level). Most patients had a significant decline in functional capacity in the short term (≤1 month from surgery). In the medium term (1 to ≤6 months from surgery), although the functional capacity did not return to the preoperative level, the decline became insignificant. This study is the first to review factors related to functional capacity in lung cancer patients. The findings can help clinicians to better identify patients at risk of functional capacity decline and allocate clinical resources more efficiently. The risk factors related to the functional capacity decline in surgical lung cancer patients should be evaluated routinely during perioperative nursing assessments. Preoperative and postoperative nursing interventions can potentially improve modifiable risk factors and prevent functional capacity deterioration.

P1 NEW TREATMENT STRATEGIES IN PATIENTS WITH SENILE CARDIAC AMYLOIDOSIS

Abstract We present the case of a 75 year–old man, diabetic, dyslipidemic, hypertensive, previous ischemic heart disease, AF, previous hospitalizations for heart failure, who underwent cardiology evaluation for worsening dyspnea (NYHA class II–III), swallen ankles and elevated BNP levels (900 pg/ml). The patient suffered from sensory–motor polyneuropathy diagnosed with EMG and ENG. Echocardiographic evaluation: severe concentric hypertrophy of the left ventricle (SIV 18 mm, PP 17 mm), granular sparkling and EF 50%, left atrium dilatation, light–moderate mitral regurgitation, moderate tricuspid regurgitation with PAPS 40–45 mmHg. Circumferential pericardial effusion (12 mm). Moreover, we noticed a decreased longitudinal contractive function of the left ventricle (TDI e‘, a’, e s’ &amp;lt;5 cm/s e absolute GLS &amp;lt; 15%), speckle–tracking ‘cherry on the top‘ and restrictive diastolic pattern. •ECG: low QRS voltage and increased wall thickness (&amp;gt;12 mm). •Laboratory: (SPIE and UPIE) no monoclonal protein present. •Bone scintigraphy: grade 3 cardiac uptake. •Cardiac MRI: asymmetric hypertrophy of the left ventricle with moderate biventricular systolic dysfunction. Subendocardial late gadolinium enhancement. •Genetic testing: no sarcomeric or TTS gene mutations. All findings were suggestive for senile cardiac amyloidosis (ATTR wt), the patient was discharged from the hospital with optimized medical therapy for heart failure and follow up was prescribed. After 3 months from the first diagnosis we added Tafamidis to the therapy (ESC indications class IB). ATTR–ACT, published on ‘New England Journal of Medicine’ showed that Tafamis is superior to placebo in reducing the combination of all–cause mortality and cardiovascular–related hospitalizations. Tafamidis was also associated with a significant reduction in the decline in functional capacity (as measured by the 6–minute walk test) and the decline in quality of life (as measured by the KCCQ–OS) at month 30, with differences first observed at 6 months. Tafamidis was well–tolerated, with a safety profile comparable to placebo. Follow–up: 6 months later the introduction of Tafamidis, the patient has not needed other hospitalizations for heart failure, well tolerates the drug with a subjective symptom reduction and remarkable improvement in quality of life.

Green space type and healthy ageing in place: An Australian longitudinal study

Research on the health benefits of people’s long-term exposure to green space is lacking. Addressing this emerging topic, this study uncovers the association of green space types with a person’s healthy ageing score (HAS). We investigated the association with HAS by continuous exposure to various green space types for two years. Green space types include tree canopy, low-lying vegetation and open grass percentage within 1.6-km road network distance buffers at baseline and second follow-up. Healthy ageing outcomes included functional capacity, resilience and HAS while accounting for relocation. This is a longitudinal study of a cohort of 22,715 New South Wales residents aged over 45 who participated in the Sax Institute’s 45 and Up Study living in Sydney, Wollongong and Newcastle. Longitudinal models of healthy ageing on green space types were fit with controls for socioeconomic confounders. Women who did not relocate were associated with a lower functional capacity (β; 95%CI: −0.10; −0.15,−0.05) and higher resilience (0.11; 0.08, 0.14) compared to those who relocated. Apart from age, personal characteristics did not explain the variation in healthy ageing outcomes for participants who moved. For participants who did not relocate, 30% grass cover was associated with decreased functional capacity (−0.22; −0.41,−0.04) and HAS (−0.31; −0.56,−0.05). Also, 5–9% low-lying vegetation was associated with a decline in functional capacity (−0.09; −0.15, −0.03) and HAS (−0.09; −0.17, −0.01) of participants who stayed but improved resilience (0.28; 0.01, 0.55) of participants who relocated. Green space comprising over 30% tree cover appeared most beneficial for functional capacity (0.42; 0.31, 0.53), resilience (0.19; 0.13, 0.25) and HAS (0.60; 0.45, 0.75). For participants who relocated, over 30% tree canopy was associated with improved functional capacity (0.33; 0.54, 0.62) but not resilience or their HAS. Increased neighbourhood tree canopy supports healthy ageing. Older people should be supported to live in-home or move into nearby residential care and maintain regular contact with green spaces and trees, to maximise potential benefits for health and wellbeing.

The Effect of Aaerobic Exercise on Functional Capacity Increase in Coronary Heart Disease Patients: A Narrative Review

The heart condition known as coronary heart disease (CHD) is brought on by the narrowing of the coronary arteries as a result of atherosclerosis, spasm, or a combination of both. This results in a disruption in the supply of oxygen and nutrients to the myocardial tissue due to a decrease in coronary blood flow and a reduction in functional capacity. Objective: The study aims to determine the effect of aerobic exercise on functional capacity increase in coronary heart disease patients. Method: The research employed a narrative review method with the PICO framework (Population/Patient/Problem, Intervention, Comparation, and Outcome). The journals were searched from 2 databases, namely Google Scholar with 15,700 articles and Pubmed 639 articles. The inclusion criteria in this study were national or international articles and full text about the effect of aerobic exercise on functional capacity decline in coronary heart patients published in 2012- 2022. Result: After reviewing the title, relevancy of the abstract, and full text of 16,334 papers from 2 databases, 10 journals demonstrated that aerobic exercise was effective to increase the functional capacity in coronary heart disease patients. Conclusion: There is an effect of aerobic exercise on functional capacity increase in coronary heart disease patients.Keywords: Aerobic Exercise, Coronary Heart Disease, Functional Capacity

Post-COVID-19 mucormycosis: A prospective, observational study in patients undergoing surgical treatment.

Post the second wave of COVID-19 in India, our institute became a dedicated center for managing COVID-19-associated mucormycosis (CAM), but there was a paucity of data regarding perioperative considerations in these patients. The objectives of present study was to describe the preoperative clinical profile, the perioperative complications and outcome of CAM patients undergoing urgent surgical debridement. This prospective observational study was conducted on CAM patients presenting for surgical debridement from July to September 2021. During preoperative visits, evaluation of extent of disease, any side effects of ongoing medical management and post-COVID-19 systemic sequalae were done. The details of anaesthetic management of these patients including airway management, intraoperative haemodynamic complications and need for perioperative blood transfusion were noted. One hundred twenty patients underwent surgical debridement; functional endoscopic sinus surgery (FESS) was carried out in 63% of patients, FESS with orbital exenteration in 17.5%, and maxillectomy in 12.5%. Diabetes mellitus was found in 70.8% and post-COVID new onset hyperglycemia in 29.1% of patients. Moderate-to-severe decline in post-COVID functional status (PCFS) scale was observed in 73.2% of patients, but with optimization, only 5.8% required ICU management. The concern during airway management was primarily difficulty in mask ventilation (17.5%). Intraoperatively, hemodynamic adverse events responded to conventional treatment for hypotension, judicious use of fluids and blood transfusion. Perioperatively, 10.8% of patients required blood transfusion and 4.2% of patients did not survive. Non-surviving patients were older, with a more aggressive involvement of CAM, and had comorbidities and a greater decline in functional capacity. A majority of patients reported a moderate-to-severe decline in PCFS that required a preoperative multisystem optimization and a tailored anesthetic approach for a successful perioperative outcome.

Meteorin-like is an injectable peptide that can enhance regeneration in aged muscle through immune-driven fibro/adipogenic progenitor signaling.

Pathologies associated with sarcopenia include decline in muscular strength, lean mass and regenerative capacity. Despite the substantial impact on quality of life, no pharmacological therapeutics are available to counteract the age-associated decline in functional capacity and/or, resilience. Evidence suggests immune-secreted cytokines can improve muscle regeneration, a strategy which we leverage in this study by rescuing the age-related deficiency in Meteorin-like through several in vivo add-back models. Notably, the intramuscular, peptide injection of recombinant METRNL was sufficient to improve muscle regeneration in aging. Using ex vivo media exchange and in vivo TNF inhibition, we demonstrate a mechanism of METRNL action during regeneration, showing it counteracts a pro-fibrotic gene program by triggering TNFα-induced apoptosis of fibro/adipogenic progenitor cells. These findings demonstrate therapeutic applications for METRNL to improve aged muscle, and show Fibro/Adipogenic Progenitors are viable therapeutic targets to counteract age-related loss in muscle resilience.

Effects of physical exercise on the functional capacity and muscle strength of patients with gastric and esophageal cancer: a systematic review

Esophageal and gastric cancers have a significant prevalence. These patients often face a decline in functional capacity (FC) and muscle strength (MS), as consequence of neoadjuvant treatments and surgical resection; however, this decline can be minimized through appropriate exercise protocols. To assess evidence of the effects of physical exercise on HR and MS in patients with esophageal and stomach cancer. Systematic review of Randomized clinical trials with intervention based on exercises for patients with esophagogastric cancer (EGC). FC and MS were the outcomes. Searches in Medline via Pubmed, PEDro, Cochrane Library, Embase and CINAHL databases were performed. Cochrane Collaboration tool and GRADE system for risk of bias assessment. From 117 articles identified, eight studies were included, involving a total of 673 patients. In general, the approach during neoadjuvant therapy had a positive effect on the 6-minute walk test (6MWT) and on FM. Exercise performed in the preoperative period showed divergent results for inspiratory muscle strength, but improved HR assessed by the 6-minute walk test (6MWT). The postoperative exercise protocol increased the FC in 6MWT, and maximal oxygen consumption (VO2max). However, it does not improve MS. Studies also showed a moderate-to-high risk of bias. Although some studies point to positive results in favor of physical exercise in improving FC and MS in patients being treated for esophagogastric cancer, the degree of clinical recommendation is low.

Recent advances in the management of pulmonary hypertension with interstitial lung disease.

Pulmonary hypertension (PH) is known to complicate various forms of interstitial lung disease (ILD), including idiopathic pulmonary fibrosis, the interstitial pneumonias and chronic hypersensitivity pneumonitis. Pathogenesis of PH-ILD remains incompletely understood, and probably has overlap with other forms of pre-capillary pulmonary hypertension. PH-ILD carries a poor prognosis, and is associated with increased oxygen requirements, and a decline in functional capacity and exercise tolerance. Despite most patients having mild-moderate pulmonary hypertension, more severe pulmonary hypertension and signs of right heart failure are observed in a subset of cases. Clinical suspicion and findings on pulmonary function, computed tomography and echocardiography are often the initial steps towards diagnosis. Definitive diagnosis is obtained by right heart catheterisation demonstrating pre-capillary pulmonary hypertension. Drugs approved for pulmonary arterial hypertension have been investigated in several randomised controlled trials in PH-ILD patients, leading to discouraging results until the recent INCREASE study. This review provides an overview of the current understanding, approach to diagnosis and recent advances in treatment.

Impairments of social cognition significantly predict the progression of functional decline in Huntington’s disease: A 6-year follow-up study

This study sought to investigate if there was a significant difference between the Huntington’s Disease gene expansion carriers who were impaired on the cognitive domains, social cognition and executive functions. Also, it was investigated which of the cognitive domains could predict the decrease in total functional capacity over a 6-year follow-up period. Premanifest and motor-manifest Huntington’s Disease gene expansion carriers (N = 98), were examined with a neurological and neuropsychological examination at Time 1 (year 2012–2013). Regression-based normative data was used to classify impairments on the two cognitive domains. Follow-up participants (N = 80) had their functional capacity reexamined at Time 2 (year 2018–2020), to examine which cognitive domain could predict the decrease in functional capacity over the 6-year follow-up. More than 50% of the participants were impaired on the domain of social cognition. These participants were significantly different from the participants who were impaired on executive functions. The motor function and impairments on social cognition significantly predicted the decline in functional capacity. The Emotion Hexagon test was the only significant social cognitive task, that predicted the decline in functional capacity. Social cognition includes unique and separate functions in Huntington’s Disease, unaffected by executive functions. This study emphasizes the importance of regular assessment of social cognition in Huntington’s Disease and the clinical relevance of impaired social cognitive function.