Increase In Arm Circumference Research Articles

Effects of branched-chain amino acids supplementation on patients undergoing hepatic intervention: a meta-analysis of randomised controlled trials.

The benefits of branched-chain amino acid (BCAA) administration after hepatic intervention in patients with liver diseases remain unclear. We conducted a systematic review and meta-analysis to evaluate the effects of BCAA on patients undergoing hepatectomy, trans-arterial embolisation and radiofrequency ablation. Relevant randomised controlled trials (RCT) were obtained from PubMed, EMBASE and Cochrane Library databases. A meta-analysis was performed to calculate the pooled effect size by using random-effects models. The primary outcomes were survival and tumour recurrence. The secondary outcomes were hospital stay, nutrition status, biochemistry profile, complication rate of liver treatment and adverse effect of BCAA supplementation. In total, eleven RCT involving 750 patients were included. Our meta-analysis showed no significant difference in the rates of tumour recurrence and overall survival between the BCAA and control groups. However, the pooled estimate showed that BCAA supplementation in patients undergoing hepatic intervention significantly increased serum albumin (mean difference (MD): 0·11 g/dl, 95 % CI: 0·02, 0·20; 5 RCT) at 6 months and cholinesterase level (MD: 50·00 U/L, 95 % CI: 21·08, 78·92; 1 RCT) at 12 months and reduced ascites incidence (risk ratio: 0·39, 95 % CI: 0·21, 0·71; 4 RCT) at 12 months compared with the control group. Additionally, BCAA administration significantly increased body weight at 6 months and 12 months and increased arm circumference at 12 months. In conclusion, BCAA supplementation significantly improved the liver function, reduced the incidence of ascites and increased body weight and arm circumference. Thus, BCAA supplementation may beneficial for selected patients undergoing liver intervention.

Paclitaxel versus docetaxel-based neoadjuvant chemotherapy and risk of lymphedema in breast cancer patients.

e12620 Background: Neoadjuvant chemotherapy (NAC) is commonly utilized in women with locally advanced breast cancer, usually followed by surgery and radiation therapy (RT). Many studies aimed to address the risk factors contributing to a higher incidence of lymphedema in patients with breast cancer. Our group previously reported the extent of surgery increases the risk of lymphedema. Adjuvant chemotherapy with taxane-based regimens are associated with an increased risk of lymphedema likely due an increase in interstitial extracellular fluid volume therefore resulting in fluid retention. This study aims to directly compare and characterize the risk of lymphedema in patients receiving paclitaxel versus docetaxel-based NAC. Methods: This is a retrospective study approved by our institutional review board. The study included women with breast cancer treated consecutively at our institution with taxane-based NAC followed by surgery and RT from 2006 to 2018. Patients and tumor characteristics including age, race, body mass index (BMI), clinical stage, hormone receptor, HER2 status, type of surgery, RT techniques, and type of NAC (Paclitaxel versus Docetaxel), and its association to risk of lymphedema were analyzed using univariable and multivariable binary logic regression tests. Lymphedema was assessed before RT and at follow up visits, and was identified by >2.0-cm increase in arm circumference, or >10% increase in limb volume, or new self-reported lymphedema symptoms. Results: A total of 263 patients treated with either paclitaxel or docetaxel-based NAC were identified and analyzed. At a median follow up of 28.4 months (range 3.5-158.7 months). 26.2% (69/263) of patients developed lymphedema. On a multivariable analysis, patients who underwent axillary lymph node dissection (ALND) had a significantly higher rate of lymphedema (42.6%) compared to those who had only a sentinel lymph node biopsy (SLNB, 10.5%, p<0.05). Regardless of the type of surgery, there was no significant difference in rates of lymphedema between patients who received paclitaxel versus docetaxel-based NAC (28.7% vs 21.3%). However, among high-risk patients who underwent mastectomy with ALND, NAC with Paclitaxel was associated with a significantly higher rate of lymphedema compared to docetaxel (56.8% vs 22.7%, RR 2.50, p<0.05). Conclusions: This represents one of the largest studies examining the impact of taxane-based NAC on the risk of lymphedema in women with breast cancer. In this study, paclitaxel-based NAC was associated with a significantly higher risk of lymphedema in women who underwent mastectomy and ALND compared to docetaxel based chemotherapy. A larger, balanced, prospective study is warranted to verify this previously unidentified lymphedema risk from paclitaxel and guide individualized NAC decision.

Contralateral effects of eccentric resistance training on immobilized arm.

This study compared the effects of contralateral eccentric-only (ECC) and concentric-/eccentric-coupled resistance training (CON-ECC) of the elbow flexors on immobilized arm. Thirty healthy participants (18-34 y) were randomly allocated to immobilization only (CTRL; n=10), immobilization and ECC (n=10), or immobilization and CON-ECC group (n=10). The non-dominant arms of all participants were immobilized (8h·day-1 ) for 4weeks, during which ECC and CON-ECC were performed by the dominant (non-immobilized) arm 3 times a week (3-6 sets of 10 repetitions per session) with an 80%-120% and 60%-90% of one concentric repetition maximum (1-RM) load, respectively, matching the total training volume. Arm circumference, 1-RM and maximal voluntary isometric contraction (MVIC) strength, biceps brachii surface electromyogram amplitude (sEMGRMS ), rate of force development (RFD), and joint position sense (JPS) were measured for both arms before and after immobilization. CTRL showed decreases (P<.05) in MVIC (-21.7%), sEMGRMS (-35.2%), RFD (-26.0%), 1-RM (-14.4%), JPS (-87.4%), and arm circumference (-5.1%) of the immobilized arm. These deficits were attenuated or eliminated by ECC and CON-ECC, with greater effect sizes for ECC than CON-ECC in MVIC (0.29: +12.1%, vs -0.18: -0.1%) and sEMGRMS (0.31:17.5% vs -0.15: -5.9%). For the trained arm, ECC showed greater effect size for MVIC than CON-ECC (0.47 vs 0.29), and increased arm circumference (+2.9%), sEMGRMS (+77.9%), and RDF (+31.8%) greater (P<.05) than CON-ECC (+0.6%, +15.1%, and+15.8%, respectively). The eccentric-only resistance training of the contralateral arm was more effective to counteract the negative immobilization effects than the concentric-eccentric training.

Resistance Training Associated with Dietetic Advice Reduces Inflammatory Biomarkers in the Elderly.

Aging is a biological process during which chronic low-grade inflammation is present due to changes in the immune system of the elderly. The main objective of this study is to evaluate the effects of resistance training associated with dietary advice on chronic inflammation in the elderly. We conducted a prospective intervention study in which we evaluated anthropometric parameters and inflammatory biomarkers (CRP, IL-8, CCL-2, and leptin) in 40 elderly people before and after long-term progressive resistance training (19 weeks) associated with dietary advice. The participants trained twice a week on nonconsecutive days, and the training lasted one hour with an intensity of 60-85% of 1-MR. Dietary advice was explained in person and individually focusing on foods rich in compounds with anti-inflammatory and antioxidant properties. Participants were instructed at the beginning of the training program, and dietary advice was reinforced verbally weekly. There was an improvement in body composition evidenced by a reduction in waist circumference and body fat percentage and by the increase in arm circumference, calf circumference, and corrected arm muscle area. In addition, there was a reduction in the inflammatory biomarkers CCL-2 (p = 0.01) and leptin (p < 0.01). Resistance training associated with dietary guidance can contribute to a healthy aging due to observed improvements in body composition and in the inflammatory profile of the elderly.

Abstract P3-14-04: Prevention of lymphedema in patients undergoing axillary dissection for breast cancer by benzathine penicillin: A non-inferiority randomised controlled trial

Abstract Background: Axillary lymph node dissection (ALND) is performed for axillary lymph nodal metastasis. Major complication of ALND is lymphedema. Lymphedema is a morbid condition associated with impaired activities of daily life and deterioration in quality of life (QOL). Olszewski et al (Lymphology. 2005 Jun;38(2):66–80) have shown that low-grade staphylococcal infection is a risk factor for lymphedema. Hence, we embarked upon a randomised controlled trial with non-inferiority hypothesis to evaluate efficacy of injection Benzathine penicillin in preventing breast cancer related lymphedema. Methods: In this 2 group, open label, parallel design randomized controlled trial; patients undergoing ALND for breast cancer were included. Patients were randomized using block randomization to either injection Benzathine penicillin group or in control group. Patients in the penicillin group received injection Benzathine penicillin 1.2 million units as deep intramuscular injection after antibiotic sensitivity testing at intervals of 3 weeks. Primary endpoint was development of lymphedema at 6 months follow up. Analyses were done on an intention to treat basis. Lymphedema was defined as increase in &amp;gt;200ml of volume on water displacement method and or increase in arm circumference of &amp;gt;2cm from pre surgery values (Lancet Oncol. 2013 May 1;14(6):500–15). Findings: Between July 2016 and December 2017, 83 ladies were randomly allocated, 40 in the penicillin group and 43 in control group. At 6 months follow up; a total of 15 (18.07%) patients had lymphedema. Out of them 5 patients were in penicillin group and 10 in the control group. Cellulitis was seen in 2/3rd of patients (10 out of 15) having lymphedema. The relative risk of cellulitis in penicillin group was 0.119 with 95% CI of (0.016-0.901) and prevented fraction of 0.881. Other factors like radiotherapy, type of surgery for primary tumor, extent of axillary dissection and type of chemotherapy were comparable in both groups. None of the patients receiving penicillin have any adverse effect or allergic reaction to the drug during the study period. Comparison of lymphedema and cellulitis in two groupsOutcome Penicillin groupControl groupRR ( 95% CI)PFLymphedemaPresent05100.538 (0.201-1.437)0.462 Absent3533 CellulitisPresent01090.119 (0.016-0.901)0.881 Absent3934 RR: Relative risk, PF: Prevented fraction, CI: Confidence interval Conclusion: Penicillin administration in patients undergoing axillary lymph node dissection is safe and significantly reduces risk of lymphedema and cellulitis. Novelty: This is the first randomised trial demonstrating the benefit of long term administration of penicillin in reducing lymphedema and cellulitis. Citation Format: Singh K, Dhar A, Srivastava A, Ranjan P, Kataria K, Gour KS. Prevention of lymphedema in patients undergoing axillary dissection for breast cancer by benzathine penicillin: A non-inferiority randomised controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-04.

Effects of Adding Single Joint Exercises to a Resistance Training Programme in Trained Women.

Background: The present study’s aim was to compare the changes in muscle performance and anthropometric measures in trained women performing RT programs composed only of MJ exercises or programmes that involve the addition of SJ exercises. Methods: Seventeen trained women were randomised to MJ or MJ+SJ. Both groups performed the same MJ exercises following a nonlinear periodisation model for 8 weeks. The only difference was that the MJ+SJ group also performed SJ exercises. The participants were tested for 10 repetition maximum (10 RM), flexed arm circumference, and both biceps and triceps skinfold. Results: Both groups significantly increased 10 RM load for the bench press (12.6% MJ and 9.2% MJ+SJ), triceps (15.6% MJ and 17.9% MJ+SJ), pull down (9.8% MJ and 8.3% MJ+SJ), biceps (14.0% MJ and 13.0% MJ+SJ), leg press (15.2% MJ and 12.8% MJ+SJ) and knee extension (10.2% MJ and 9.1% MJ+SJ). The decreases in triceps (−5.1% MJ and −5.3% MJ+SJ) and biceps (−6.5% MJ and −5.7% MJ+SJ) skinfolds were also significant as were the increases in arm circumference (1.47% MJ and 1.58% MJ+SJ). In all tests there was nothing significantly different between groups. Conclusions: The use of SJ exercises as a complement to a RT programme containing MJ exercises brings no additional benefit to trained women.

Does the addition of single joint exercises to a resistance training program improve changes in performance and anthropometric measures in untrained men?

The present study compared changes in muscle performance and anthropometric measures in young men performing resistance training (RT) programs composed of only multi joint (MJ) exercises, or with the addition of single joint (SJ) exercises (MJ+SJ). Twenty untrained men were randomized to MJ or MJ+SJ groups for 8 weeks. Both groups performed the same MJ exercises. The difference was that the MJ+SJ group added SJ exercises for upper and lower limbs. Participants were tested for 10 repetitions maximum (10RM), flexed arm circumference, and biceps and triceps skinfolds. Both groups significantly increased 10RM load for the bench press (MJ 38.5%, MJ+SJ 40.1%), elbow extension (MJ 28.7%, MJ+SJ 31.9%), pull down (MJ 34.0% MJ+SJ 38.5%), elbow flexion (MJ 38.2%, MJ+SJ 45.3%), leg press (MJ 40.8%, MJ+SJ 46.8%) and knee extension (MJ 26.9%, MJ+SJ 32.9%), with no significant difference between them. The decreases in biceps (MJ -3.6%, MJ+SJ –3.9%) and triceps (MJ –3.4%, MJ+SJ -3.3%) skinfolds were significant for both groups, with no difference between them. However, the flexed arm circumference increased significantly more for MJ+SJ (5.2%), than for MJ (4.0%). The use of SJ exercises as a complement to a RT program containing MJ exercises brings no additional benefit to untrained men in terms of muscle performance and skinfold reduction, though it promoted higher increases in arm circumference.

Obesity-Related Hypertension in Children.

Obesity and hypertension have both been on the rise in children. Each is associated with increased cardiovascular disease risk and both track into adulthood, increasing the prevalence of heart disease and related morbidity and mortality. All children should be screened for hypertension, but children with comorbid obesity may not only particularly benefit from the screening but may also prove the most challenging to screen. Increased arm circumference and conical arm shape are particularly problematic when attempting to obtain an accurate blood pressure (BP) measurement. This review focuses on the unique aspects of hypertension evaluation and management in the child with comorbid obesity. Specific traditional and non-traditional risk factors that may contribute to elevated BP in children with obesity are highlighted. Current proposed pathophysiologic mechanisms by which obesity may contribute to elevated BP and hypertension is reviewed, with focus on the role of the sympathetic nervous system and the renin–angiotensin–aldosterone system. This review also presents a targeted treatment approach to children with obesity-related hypertension, providing evidence for the recommended therapeutic lifestyle change that should form the basis of any antihypertensive treatment plan in this population of at-risk children. Advantages of specific pharmacologic agents in the treatment of obesity-related hypertension are also reviewed.

Nutritional assessment of newborns regarding preconceptional maternal body mass index

BACKGROUND: Obesity and overweight in pregnancy have a significant impact in fetal development. However, this association remains controversial. OBJECTIVE: assess the association between maternal preconception body mass index (BMI) and the newborn nutritional status. MATERIAL AND METHODS: Prospective study, where singleton births were included. Newborns were classified according to their mother’s preconception BMI and anthropometric measurements were taken to evaluate the newborn’s nutritional status. For the statistical análisis we present descriptive statistics for the main variables and we fitted lineal regression models. RESULTS: A total of 492 dyads were included, 30.7% of the mothers had overweight or obesity. We found that mothers with overweight or obesity tend to have products with higher birth weight (?=0.01; IC95% (0.002,0.019) p0.015), increased arm circumference (?=0.02; IC95% (0.001,0.045) p0.037) and a tendency of lower length at birth (?=0.002; IC95% (-0.003,0.0002) p0.19) CONCLUSIONS: There are significant changes in the newborns anthropometric measures of mothers with higher BMI; therefore there could be an association between maternal preconception overweight and obesity with abnormal intrauterine growth.

Risk factors associated with catheter-related upper extremity deep vein thrombosis in patients with peripherally inserted central venous catheters: a prospective observational cohort study: part 2.

This is the second part of a 2-part series that reports on the results of a prospective observational cohort study designed to examine risk factors associated with symptomatic upper extremity deep vein thrombosis (UEDVT) in patients with peripherally inserted central catheters (PICCs). Part 1, published in the May/June 2014 issue of the Journal of Infusion Nursing, provided an extensive review and critique of the literature regarding risk factors associated with catheter-related UEDVT and identified 28 suspected risk factors. A study was undertaken to examine each of the risk factors among 203 acute care patients with PICCs, 13 of whom experienced a UEDVT, yielding an incidence of 6.4%. The most common reason for admission was infection (33.5%), and the primary reason for insertion of the PICC was venous access (58.6%). Hypertension (P = .022) and obesity (P = .008), defined as a body mass index ≥30, were associated with UEDVT. The clinical symptoms of edema (P < .001) and a 3-cm or more increase in arm circumference (P < .001) in the PICC arm after PICC placement were associated with UEDVT. All other variables were not statistically significant. The results suggest that patients who are obese and hypertensive may be at greater risk for the development of UEDVT and that the physical finding of edema and increased arm circumference in the PICC arm are possibly suggestive of UEDVT.

Complete versus Selective Axillary Lymph Node Dissection in Treatment of Early Breast Carcinoma

Axillary lymph node dissection for staging the axilla in breast carcinoma patients is associated with considerable morbidity, such as edema of the arm, pain, sensory disturbances, impairment of arm mobility, and shoulder stiffness. Selective lymph node biopsy electively removes the palpable lymph node, which gets the drainage from the tumor and should therefore be associated with nearly zero morbidity. Postoperative morbidity (increase in arm circumference, subjective lymphedema, pain, numbness, effect on arm strength and mobility, and stiffness) of the operated arm was prospectively compared in 20 breast carcinoma patients after axillary lymph node dissection (ALND) and 20 patients following Selective lymph node (SLN) biopsy. Patient characteristics were comparable between the two groups. Postoperative follow-up was 15.4 months (range, 4-24 months) in the SLN group and 17.0 months (range, 4-24 months) in the ALND group. Following axillary dissection, patients showed a significant increase in upper and forearm circumference of the operated arm compared with the SLN patients, as well as a significantly higher rate of subjective lymphedema, pain, numbness, and motion restriction. Neither difference between groups regarding arm stiffness or arm strength, nor did the type of surgery affect daily living.

Factors related to insomnia and sleepiness in the late third trimester of pregnancy

To assess the presence of insomnia and sleepiness and related factors in the late third trimester of pregnancy. A total of 370 singleton gravids completed a general questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). In addition, maternal anthropometry was recorded upon survey. Median [interquartile range] maternal age and gestational age upon survey was of 31 [7.0] years and 39 [1.8] weeks, respectively. A 73.5% of women displayed some degree of insomnia (Total ISI score 8-28) and 22.2% sleepiness (Total ESS score ≥10). Determined rho Spearman coefficients showed significant correlations between ISI scores and gestational age at survey and survey to birth interval (weeks) and between ESS scores and maternal weight and arm circumference at survey and neonatal birth weight. Multiple linear regression analysis found that smoking habit, higher blood pressure and shorter survey to birth interval (weeks) significantly predicted higher ISI scores, and hence a higher risk of insomnia. Employed status, increased arm circumference and neonatal weight predicted higher ESS scores (sleepiness). Insomnia and sleepiness were prevalent in the late third trimester of pregnancy in which lifestyle factors and maternal and neonatal body composition were significant predictors.

Anabolic-Androgenic Steroids

The use of anabolic-androgenic steroids (AAS) among athletes is not new, nor is concern about their potential cardiac effects, but it has been difficult to definitively document deleterious cardiovascular effects from these drugs. There are case reports of unexpected myocardial infarctions1 and even sudden cardiac death2 in AAS users, but such reports are relatively rare given the reported widespread use of AAS. Moreover, their effects on cardiovascular risk factors are confusing. Oral synthetic steroids, such as stanozolol, reduce high-density lipoprotein and increase low-density lipoprotein cholesterol more than parenterally administered testosterone at similar androgenic doses,3 suggesting that oral AAS are more atherogenic, but both stanozolol4 and testosterone5 decrease lipoprotein (a), an important atherosclerotic risk factor. There is also concern that AAS increase blood pressure, but even the literature on this topic is equivocal,6 and some of the purported increase in blood pressure with AAS may be due to the use of undersized sphygmomanometer cuffs in subjects with increased arm circumference.7 Consequently, the overall clinical effect of …

Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial

Objective To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer.Design Randomised, single blinded, clinical trial.Setting University hospital in Alcalá de...

Effect Of Comprehensive Exercise On Lymphedema In Breast Cancer Survivors: A Pilot Study

One in nine women are diagnosed with breast cancer. Early diagnosis and better treatments are allowing women to survive longer. With this positive trend, greater attention is being focused on survivorship issues such as lymphedema, which affects 5-30% of patients who have undergone treatment for breast cancer. Previously there was a concern that aerobic exercise and resistance training in the effected arm may cause or worsen lymphedema. Limited studies have provided preliminary evidence to suggest that exercise may be safe. PURPOSE: To examine changes in strength and arm circumferences (as a measurement of lymphedema) in 32 breast cancer survivors before and after undergoing a comprehensive exercise program. METHODS: This retrospective study reviewed results of 32 breast cancer survivors (mean age 51, range 26-76) who voluntarily enrolled in a comprehensive fitness program. Twenty-two percent of the women had lymphedema at baseline. Cancer treatment included a combination of mastectomy (60%), lumpectomy (40%), axillary node dissection (69%), sentinel node biopsy (28%), radiation therapy (69%) and chemotherapy (88%). Participants completed a supervised exercise program 2-3 times per week including aerobic and resistance exercise. Arm circumference (sub-axillary, upper arm and forearm) were obtained at baseline and after an average of 22 weeks (range 12-40 weeks) of training. Pre and post exercise measurements in arm circumference and biceps curl strength were assessed for all women as a group, as well as for subgroups by treatment type, using two-tailed t-tests. Results: Compliance with the training program was excellent (83%). There was no significant increase in arm circumference post exercise for the entire group, nor for any treatment subgroup. Interestingly, the sub-axillary measurement showed a significant decrease in circumference (p=0.05) for the entire group. Biceps strength increased for the entire group as well as for all subgroups (p<0.05). CONCLUSION: Participation in a comprehensive exercise program for breast cancer survivors was well tolerated. The women demonstrated a decrease in sub-axillary arm circumference with concurrent improvements in biceps strength. This study supports the limited body of literature supporting the safety and efficacy of exercise in this population.

Hemodynamic and Vascular Response to Resistance Exercise with l-Arginine

L-arginine, the precursor to nitric oxide (NO), has been shown to improve endothelial function in patients with endothelial dysfunction. Resistance exercise has been shown to increase arterial stiffness acutely with no definitive cause. It is possible that a reduction in NO bioavailability is responsible for this. The purpose of this study was to examine the effect of acute L-arginine supplementation and resistance exercise on arterial function. Eighteen (N = 18) young men (24.2 +/- 0.7 yr) volunteered for this study. In a crossover design, subjects underwent body composition testing, 1-repetition maximum testing for the bench press and the biceps curls and performed two acute bouts of resistance exercise in which they consumed either placebo or 7 g L-arginine before each resistance exercise bout. Anthropometric measures, augmentation index (AIx), arterial stiffness, and forearm blood flow (FBF) were assessed before and after each treatment condition. There were significant (P < 0.05) time effects after the resistance exercise; there was a reduction in brachial stiffness (P = 0.0001), an increase in central aortic stiffness (P = 0.004), an increase in AIx (P = 0.023), an increase in FBF (P = 0.000), and an increase in arm circumference (P = 0.0001) after exercise. The increase in central arterial stiffness and wave reflection was not attenuated by acute supplementation with L-arginine; furthermore, blood flow was not augmented with supplementation. On the basis of these data, l-arginine does not appear to change the hemodynamic and vascular responses to resistance exercise.

Breast Cancer–Related Lymphedema: Attention to a Significant Problem Resulting From Cancer Diagnosis

Breast Cancer–Related Lymphedema: Attention to a Significant Problem Resulting From Cancer Diagnosis

Prevalence of post-thrombotic syndrome following asymptomatic thrombosis in survivors of acute lymphoblastic leukemia.

Deep vein thrombosis (DVT) is a complication of treatment of acute lymphoblastic leukemia (ALL) in children but little is known about the long-term outcomes of these DVT. To determine the incidence of post-thrombotic syndrome (PTS) in (i) children with ALL diagnosed with asymptomatic DVT using radiographic testing and (ii) an unselected group of ALL survivors. Cross-sectional study in two populations. Group I comprised children in the Prophylactic Antithrombin Replacement in Kids with ALL treated with L-Asparaginase (PARKAA) study diagnosed with DVT by radiographic tests. Group II consisted of non-selected childhood ALL survivors <21 years. PTS was assessed using a standardized scoring sheet. Group I: 13 PARKAA patients (median age 12 years) were assessed, and 7 had PTS (54%; 95% CI, 25-81). All patients had collaterals, three also had increased arm circumference. Group II: 41 patients (median age 13 years) with a history of ALL were enrolled, and 10 had PTS (24%; 95% CI, 11-38). All patients had collaterals; five also had increased arm circumference. There is a high incidence of PTS in survivors of childhood ALL with radiographically diagnosed asymptomatic DVT. A significant proportion of ALL survivors develop PTS, indicating previously undiagnosed DVT.

Incidence of Post-Thrombotic Syndrome Following Asymptomatic Thrombosis in Survivors of Childhood Acute Lymphoblastic Leukemia.

BACKGROUND: Asymptomatic deep venous thrombosis (DVT) are well-known complications of treatment of acute lymphoblastic leukemia (ALL) in children. However, the clinical significance of radiographically detected, asymptomatic DVT is unclear and controversial, as there are no studies on long-term outcome of asymptomatic DVT in children available. There are two likely reasons for the studies not being done in this area. First, there is a lack of defined cohorts of pediatric patients screened for DVT and secondly, there is a great deal of difficulty in following patients over many years. The study, Prophylaxis with Antithrombin Replacement in Kids with ALL treated with L-Asparaginase (PARKAA) was a multicentre randomized controlled trial in which children with ALL were screened for DVT. As survivors of childhood cancer, the PARKAA cohort continues to be followed in their respective centers. Therefore, establishment of the PARKAA cohort (1997–99) and the ability to locate these patients provided a unique opportunity to study the long-term outcome of asymptomatic DVT.OBJECTIVE: To assess the incidence of PTS in children with ALL who previously had an asymptomatic DVT. The objective were approached in two ways. Firstly, to assess the outcome of asymptomatic DVT by determining the prevalence of PTS in children with a history of ALL with radiographically diagnosed DVT (PARKAA cohort); secondly, to corroborate the findings by determining the prevalence of PTS in an unselected group of survivors of childhood ALL.METHODS: Cross-sectional study in two separate populations: Group I comprised of children enrolled in the PARKAA multicentre study who had been screened for, and diagnosed with, DVT in the upper venous system. Group II consisted of non-selected patients < 21 years with a history of ALL followed at Stollery Children's Hospital, Edmonton. Patients were invited for a follow-up at their treatment centre (Group I) or were assessed for PTS childhood cancer survivor clinic (Group II). PTS was assessed by two of the investigators (Group I) or by the attending oncologist (Group II), respectively, using a standardized scoring sheet.RESULTS: Group I: 13 PARKAA patients with a history of ALL and objectively diagnosed DVT were assessed for PTS (4 males; median age 11.9 years; median age at diagnosis of ALL 4.4 years). 7/13 patients had PTS (54%, 95%CI 25;81). All patients with PTS had collaterals on examination, 3 also had increased arm circumference. Group II: 41 patients with a history of ALL were enrolled (61% males; median age at diagnosis 3.0 years; 28% high-risk, 67% standard risk). Mean length of follow-up since diagnosis was 9.5 years. PTS was diagnosed in 10/41 (24%; 95%CI 11–38) patients. All patients with PTS had collaterals on examination, 5 (50%) also had increased arm circumference.CONCLUSIONS: There is a clinically significant prevalence of PTS in children with a history of ALL and radiographically diagnosed DVT. A significant proportion of survivors of ALL develop PTS, indicating previously undiagnosed DVT in this population.

Eccentric exercise as an adjuvant to influenza vaccination in humans

The immune response to vaccination in animals can be enhanced by exposure to acute stress at the time of vaccination. The efficacy of this adjuvant strategy for vaccination in humans requires investigation. The current study employed a randomised controlled trial design to examine the effects of eccentric exercise prior to influenza vaccination on the antibody and cell-mediated responses. Sixty young healthy adults (29 men, 31 women) performed eccentric contractions of the deltoid and biceps brachii muscles of the non-dominant arm (exercise group) or rested quietly (control group), and were vaccinated 6 h later in the non-dominant arm. Change in arm circumference and pain were measured to assess the physiological response to exercise. Antibody titres were measured pre-vaccination and at 6- and 20-week follow-ups. Interferon-γ in response to in vitro stimulation by the whole vaccine, an index of the cell-mediated response, was measured 8 weeks post-vaccination. Interferon-γ responses were enhanced by exercise in men, whereas antibody titres were enhanced by eccentric exercise in women but not in men. Men showed greater increase in arm circumference after eccentric exercise than women but there was no difference in reported pain. The interferon-γ response was positively associated with the percentage increase in arm circumference among the exercise group. Eccentric exercise exerted differential effects on the response to vaccination in men and women, with enhancement of the antibody response in women, but enhancement of the cell-mediated response in men. Eccentric exercise of the muscle at the site of vaccine administration should be explored further as a possible behavioural adjuvant to vaccination.