Mean Change Range Research Articles

Exercise interventions in solid organ transplant candidates: A systematic review.

Exercise training may be recommended to solid organ transplant (SOT) candidates to improve fitness and tolerance before surgery. We aimed to determine the acceptance, safety, and effectiveness of exercise interventions in SOT candidates. Online databases were searched. Studies of any design were included. Outcomes of interest were acceptance, safety, exercise capacity, and health-related quality of life. Twenty-three articles were included. Acceptance ranged from 16% to 100%. In the fifteen studies that assessed adverse events, none mentioned any adverse events occurring during the study. Five out of seven studies reported an increase in maximal exercise capacity post-exercise in the intervention group (range of mean change: 0.45 to 2.9mL/kg). Eight out of fourteen studies reported an increase in 6-minute walking distance in the intervention group after the training period (range of mean change: 40-105m). Two articles showed an improvement in the mental composite scores as well as in the physical composite scores post-exercise in the intervention group. There was a lack of significant findings among most randomized controlled trials. Exercise training is acceptable and safe for selective SOT candidates. The effects of exercise training on exercise capacity and quality of life in SOT candidates are unclear.

A high-efficiency MUF method benefits postoperative hemodynamic stability and oxygen delivery in neonates with transposition of great arteries.

To minimize the postoperative hemodynamic changes in neonates with transposition of great arteries (TGA) by modifying the circuit and efficiency of traditional modified ultrafiltration (MUF). Ninety-one patients (<5 kg) underwent arterial switch operations, which were randomized to a traditional MUF (tMUF) group (N = 38) or a modified MUF (mMUF) group (N = 53). MUF of both the groups lasted for 8 to 12 minutes, during which the near-infrared spectroscopy was used to monitor cerebral tissue oxygenation parameters. The cerebral oxygenation was significantly improved after MUF in both groups. The tissue hemoglobin concentration index (THI) was proportional to the total cerebral hemoglobin during MUF. The ascending velocity of THI was faster in the mMUF group. The mean change range in the mMUF group was 0.90 ± 0.44 mM/cm, while that in the tMUF group was 0.51 ± 0.35 mM/cm (P = 0.028). Quantitative changes in the cerebral concentration of oxygenated hemoglobin increased faster in the mMUF group, in which a nadir of low efficacy MUF was not observed. The rising velocity of the tissue oxygenation index was faster in the mMUF group. All mMUF cases had stable hemodynamics during MUF. The tMUF was aborted in two patients because of unstable hemodynamics. At the end of MUF, hematocrit was significantly greater in the mMUF group than in the tMUF group (40.33 ± 5.43% vs 34.41 ± 5.11%; P < 0.01) CONCLUSION: The mMUF circuit is more miniaturized and less prime, which leads to more efficient ultrafiltration. It benefits postoperative hemodynamic stability and oxygen delivery in neonates with TGA.

Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review.

Estimating the quantitative effect of transcatheter mitral valve repair on functional parameters and quality of life is important for individual treatment decision-making. We combined data from a prospective monocentric cohort study (N=215) with data from a systematic literature review (PubMed search term "mitraclip", till 30.04.2016) on patients undergoing MitraClip with at least mortality after discharge reported as an outcome. Effects on functional parameters were reported as range of mean change. 36 observational studies and 1 randomized controlled trial were identified. Due to substantial heterogeneity of effect estimates (I 2-heterogeneity >75%) and inadequate quality of studies with a lack of comparison group in 97.4% and lack of an independent assessment of outcomes in 86.8%, no pooled estimates were calculated. All studies reported improvements of mean New York Heart Association (NYHA) class (0.5-1.9 classes), Short-Form (SF)-12/36 scores (4.4-9.2 for physical component score, 2.6-8.9 for mental component score), 6-min walk distance [(6MWD) 2-336m] and Minnesota Living with Heart failure questionnaire (MLWHFQ) score (-7 to -18 points), with improvements regarded as clinically relevant in 20 of 29 studies for NYHA class, in all of 7 studies for SF12/36, in 9 of 15 studies for 6MWD and in all of 8 studies for MLWHFQ. MitraClip therapy provides improvements in physical capacity, physical and mental functioning and disease-specific quality of life in the majority of patients. However, more comparative and high-quality studies are required for understanding the heterogeneity of results, which is crucial for optimal patient selection.

Reliability and Responsiveness of the Korean Version of the Trunk Impairment Scale for Stroke Patients

Purpose: The purposes of this study were to develop the Korean version of the trunk impairment scale (K-TIS) and to examine reliability and responsiveness of the K-TIS in patients with stroke. Methods Subjects of the study were 51 stroke patients (mean age: 57.78 years) recruited from two stroke clinics. For the interrater and test-retest reliability, two raters measured the K-TIS two times using video clips with an interval of 2 weeks. For the responsiveness, in tensive physical therapy training was provided to all participants 2 times a day for one month or three months depending on the onset of the stroke and the admission rules of the two clinics. Inter-rater reliability and test-retest reliability of the K-TIS three subscales (static sitting balance, dynamic sitting balance, and coordination) scores and total scores were examined using intra-correlation coefficient (ICC3,1) and Pearson`s correlation coefficient (r). To examine responsiveness, the minimally important difference (MID) was calculated with effect size. Results: Inter-rater reliability of the K-TIS subscales and total scores were all high (ICC3,1=0.920-0.983 and r=0.924-0.984). For the test-retest reliability, ICC3,1=0.805-0.901 and r=0.806-0.903, and the MID for acute and post-acute as well as chronic stroke patients remained in the mean change range. Conclusion: It is suggested that the K-TIS might be used for clinical and research purposes as a standardized tool for stroke patients. In addition, it can also be useful in establishment of treatment goal(s) and planning treatment program(s) for patients with stroke.

Higher Erythrocyte n–3 PUFAs Are Associated with Decreased Blood Pressure in Middle-Aged and Elderly Chinese Adults

Previous studies suggested that blood fatty acids (FAs) might affect blood pressure (BP), but the findings have been inconclusive. This study evaluated the cross-sectional and prospective associations of erythrocyte FAs with BP in middle-aged and elderly Chinese individuals. Between 2008 and 2010, 1834 participants (1364 women and 470 men) aged 57 ± 5 y had baseline measurements taken of their erythrocyte FAs and BP. A total of 1477 participants (1103 women and 374 men) had their BP measured again after 3.09 ± 0.32 y (range: 2.91–3.26 y). In the cross-sectional analyses (n = 1834), the erythrocyte saturated FA (SFA) content was positively associated with BP, whereas total cis polyunsaturated FAs (PUFAs), their subtypes cis n–3 (ω-3) PUFAs and cis n–6 (ω-6) PUFAs, and the PUFA-to-SFA ratio were inversely associated with BP (all P-trends < 0.05). The longitudinal results (n = 1477) showed marginally inverse associations between cis n–3 PUFAs and the n–3:n–6 PUFA ratio and BP. For individual cis n–3 PUFAs, higher contents of 20:5n–3, 22:5n–3, and 22:6n–3 were significantly associated with reduced increases in SBP over time (the mean change range between quartile 4 and quartile 1 was −0.917 to −0.749 mm Hg for SBP; all P-trends < 0.01), and 20:5n–3 was inversely associated with DBP change (the mean change between quartile 4 and quartile 1 was −0.631; P-trend < 0.001). Path analyses suggested that the associations between cis n–3 PUFAs and BP might be mediated by decreasing serum triglycerides (TGs) and body mass index (BMI). Our findings revealed that a higher content of cis n–3 PUFAs (mainly very long-chain cis n–3 PUFAs) may benefit BP progress, probably mediated by decreasing serum TGs and BMI.

Functional status and quality of life after transcatheter aortic valve replacement: a systematic review.

The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. To evaluate the changes in functional status and quality of life after TAVR. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range of mean change was summarized. We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making.

Ventricular performance in human hearts aged 61 to 73 years

The effects of increasing and decreasing cardiac preload by 15% on the left ventricular (LV) performance of 11 carefully screened normal subjects aged 61 to 73 years were examined. Comparisons were made with 11 subjects aged 21 to 28 years. Two-dimensional echocardiograms were obtained before and at the termination of 5 degrees of head-down tilt for 90 minutes and at the termination of graded lower body negative pressure to −40 mm Hg. Heart rates and blood pressures were unchanged after physiologic interventions. Changes in LV end-diastolic and stroke volumes were similar but of a smaller magnitude in the older subjects compared with changes in younger subjects. When LV end-diastolic volumes obtained at each extreme of preload variation were compared, the range of mean change was less in the older (23 ml, 26%) than in the younger subjects (31 ml, 41%). Control LV end-diastolic and end-systolic volumes were greater in the older subjects. This study shows that despite larger control LV volumes, alterations in preload produce changes in the LV end-diastolic and stroke volumes of these older subjects that conform to the normal LV function curve, but that these responses are diminished compared with changes in younger subjects, suggesting an age-related change in diastolic stiffness.

GCM-derived climatic change scenarios due to a CO2-doubling applied for the Mediterranean area

For the estimation of a potential climatic change induced by a doubling of atmospheric CO2 we use the results of three-dimensional general circulation models (GCM). Although the results from present climate modeling cannot be considered as predictions of future climatic conditions due to the inherent models' deficiencies, they can still serve a useful purpose in climate change scenarios. The reason for this is that climate models are the only tools available to study the response of the climate system to a perturbation in a physically consistent manner and that such types of models can provide a consistent data set of high temporal and spatial resolution. For the Mediterranean area, the results obtained from three different GCMs, namely, the British Meteorological Office model (BMO), the Goddard Institute for Space Studies model (GISS), and the National Center for Atmospheric Research model (NCAR) are shown. The regional and seasonal distributions of temperature, precipitation, and soil moisture are used to study the potential changes. The results indicate that the CO2-induced changes for temperature generated by the three models are of similar magnitude. The values of the area mean change range between 2.5 and 4.0 K. The precipitation response results in a diverse pattern. The physical mechanism likely to be responsible for the simulated climatic changes are identified and their statistical significance is tested. This type of work will help us develop the methodology and assist us in gaining insight into the use of climate model scenarios for impact analysis.