Does Cryotherapy Hasten Return to Participation? A Systematic Review

OBJECTIVE: To search the English-language literature for original research addressing the effect of cryotherapy on return to participation after injury. DATA SOURCES: We searched MEDLINE, the Physiotherapy Evidence Database, SPORT Discus, the Cochrane Reviews database, and CINAHL from 1976 to 2003 to identify randomized clinical trials of cryotherapy. Key words used were cryotherapy, return to participation, cold treatment, ice, injury, sport, edema, and pain. DATA SYNTHESIS: Original research, including outcomes-assessment measures of return to participation of injured subjects, was reviewed using the Physiotherapy Evidence Database (PEDro) Scale. Four studies were identified and reviewed by a panel of certified athletic trainers. The 4 articles' scores ranged from 2 to 4 on the PEDro scale, which has a maximum of 10 points. Two of the articles suggested that cryotherapy speeds return to participation after ankle sprains. However, these authors failed to provide in-depth statistical analysis of their results. A confounding factor of compression as part of the treatment prevented interpretation of the effects of cryotherapy in 1 article. CONCLUSIONS: After critically reviewing the literature for the effect of cryotherapy on return-to-participation measures, we conclude that cryotherapy may have a positive effect. Despite the extensive use of cryotherapy in the management of acute injury, few authors have actually examined the effect of cryotherapy alone on return-to-participation measures. The relatively poor quality of the studies reviewed is of concern. Randomized, controlled clinical studies of the effect of cryotherapy on acute injury and return to participation are needed to better elucidate the treatment responses.     

Does Liver Resection Provide Long-Term Survival Benefits for Breast Cancer Patients with Liver Metastasis? A Single Hospital Experience

Purpose

Liver resection with colorectal liver metastasis widely accepted and has been considered safe and effective therapeutic option. However, the role of liver resection in breast cancer with liver metastasis is still controversial. Therefore, we reviewed the outcome of liver resection in breast cancer patients with liver metastases in a single hospital experiences.

Materials and Methods

Between January 1991 and December 2006, 2176 patients underwent breast cancer surgery in Gangnam Severance Hospital. Among these patients, 110 cases of liver metastases were observed during follow-up and 13 of these patients received liver resection with potential feasibility to achieve an R0 resection.

Results

The median time interval between initial breast cancer and detection of liver metastasis was 62.5 months (range, 13-121 months). The 1-year and 3-year overall survival rates of the 13 patients with liver resection were 83.1% and 49.2%, respectively. The 1-year and 3-year overall survival rates of patients without extrahepatic metastasis were 83.3% and 66.7% and those of patients with extrahepatic metastasis were 80.0% and 0.0%, respectively (p=0.001).

Conclusion

Liver resection for metastatic breast cancer results in improved patient survival, particularly in patients with solitary liver metastasis and good general condition.     

Are Breast Cancer Molecular Classes Predictive of Survival in Patients with Long Follow-Up?

In this study we investigate the clinical outcomes of 305 breast cancer (BC) patients, aged 55 years or younger, with long follow-up and according to intrinsic subtypes. The cohort included 151 lymph node negative (LN−) and 154 lymph node positive (LN+) patients. Luminal A tumors were mainly LN−, well differentiated, and of stage I; among them AR was an indicator of good prognosis. Luminal B and HER2 positive nonluminal cancers showed higher tumor grade and nodal metastases as well as higher proliferation status and stage. Among luminal tumors, those PR positive and vimentin negative showed a longer survival. HER2-positive nonluminal and TN patients showed a poorer outcome, with BC-specific death mostly occurring within 5 and 10 years. Only luminal tumor patients underwent BC death over 10 years. When patients were divided in to LN− and LN+ no differences in survival were observed in the luminal subgroups. LN− patients have good survival even after 20 years of follow-up (about 75%), while for LN+ patients survival at 20 years (around 40%) was comparable to HER2-positive nonluminal and TN groups. In conclusion, in our experience ER-positive breast tumors are better divided by classical clinical stage than molecular classification, and they need longer clinical follow-up especially in cases with lymph node involvement.     

Does Phototherapy Enhance Skeletal Muscle Contractile Function and Postexercise Recovery? A Systematic Review

Context

Recently, researchers have shown that phototherapy administered to skeletal muscle immediately before resistance exercise can enhance contractile function, prevent exercise-induced cell damage, and improve postexercise recovery of strength and function.

Objective

To critically evaluate original research addressing the ability of phototherapeutic devices, such as lasers and light-emitting diodes (LEDs), to enhance skeletal muscle contractile function, reduce exercise-induced muscle fatigue, and facilitate postexercise recovery.

Data Sources

We searched the electronic databases PubMed, SPORTDiscus, Web of Science, Scopus, and Rehabilitation & Physical Medicine without date limitations for the following key words: laser therapy, phototherapy, fatigue, exercise, circulation, microcirculation, and photobiomodulation.

Study Selection

Eligible studies had to be original research published in English as full papers, involve human participants, and receive a minimum score of 7 out of 10 on the Physiotherapy Evidence Database (PEDro) scale.

Data Extraction

Data of interest included elapsed time to fatigue, total number of repetitions to fatigue, total work performed, maximal voluntary isometric contraction (strength), electromyographic activity, and postexercise biomarker levels. We recorded the PEDro scores, beam characteristics, and treatment variables and calculated the therapeutic outcomes and effect sizes for the data sets.

Data Synthesis

In total, 12 randomized controlled trials met the inclusion criteria. However, we excluded data from 2 studies, leaving 32 data sets from 10 studies. Twenty-four of the 32 data sets contained differences between active phototherapy and sham (placebo-control) treatment conditions for the various outcome measures. Exposing skeletal muscle to single-diode and multidiode laser or multidiode LED therapy was shown to positively affect physical performance by delaying the onset of fatigue, reducing the fatigue response, improving postexercise recovery, and protecting cells from exercise-induced damage.

Conclusions

Phototherapy administered before resistance exercise consistently has been found to provide ergogenic and prophylactic benefits to skeletal muscle.Key Words: photobiomodulation, laser therapy, skeletal muscle fatigue

Key Points

• • Phototherapy administered before resistance exercise may enhance contractile function, reduce exercise-induced muscle damage, and facilitate postexercise recovery.
• • The effectiveness of phototherapy is dose dependent, so selecting appropriate treatment variables, such as wavelength and output power, is important.
• • In attempting to reproduce clinical outcomes, clinicians and researchers should use evidence-based decision making when selecting treatment variables in phototherapy.
• • Given the increased beam reflection and attenuation at the skin interface, a larger treatment dose may be necessary when using light-emitting diodes (LEDs) instead of a semiconductor laser.

Phototherapy involves the therapeutic use of light to treat various pathologic conditions and musculoskeletal injuries. Research addressing the ability of light therapy to modulate physiologic processes associated with injury and healing has yielded promising results. Such modulatory processes associated with phototherapy often are called photobiomodulation (PBM), which involves the use of light to induce biochemical changes in tissue in a stimulatory or inhibitory manner.¹The use of light as a clinical modality has increased greatly over the past decade. The beneficial outcomes of phototherapy for the treatment of acute and chronic musculoskeletal disorders include pain control,^2,3 enhanced blood circulation,⁴ and improved tissue repair.⁵ Although evidence is available on how light is absorbed by tissue and cells, the biochemical translation to alter clinical outcomes in humans remains poorly understood. The biological effects of phototherapy are mediated by the absorption of photons (light particles) by endogenous chromophores and the subsequent transduction of light energy into chemical energy inside the plasma membrane or cytosolic organelle.⁶ Membrane-bound chromophores act as photosensitizers that induce changes in membrane permeability and transport mechanisms that give rise to intracellular changes in pH, ion concentrations, and membrane excitability.^7,8 Photons that penetrate the cell membrane often will enter mitochondria, where they readily are absorbed by cytochrome enzymes (eg, cytochrome c oxidase), generating physiologic responses conducive to the production of reactive oxygen species and increased rates of adenosine 5′-triphosphate (ATP) and protein synthesis.^1,9 The reactive oxygen species concentrations below cytotoxic levels have been shown to create biostimulatory effects for the cell.¹⁰Recently, researchers have begun to explore the ergogenic effects of phototherapy in delaying the onset or resisting the effects of muscle fatigue and exhaustion. Acutely, fatigue impairs muscular strength and motor control and reduces a muscle''s capacity to perform work over a designated period.¹¹ The decrease in muscle function associated with fatigue is believed to be a result of metabolic alterations, such as substrate depletion (lack of ATP and glycogen), oxidative stress, tissue hypoxia, and blood acidification.¹¹ Researchers also have indicated that specific doses of phototherapy reduce blood lactate and inflammatory biomarker levels after strenuous upper and lower extremity exercise.^12,13 Based on these findings, one may infer that phototherapy also provides a prophylactic effect to tissue by limiting exercise-induced cellular damage. Limiting inflammation and cell damage during exercise also can improve recovery of muscle strength and function postexercise. Therefore, the purpose of our systematic review was to determine the ability of phototherapeutic devices, such as lasers and light-emitting diodes (LEDs), to enhance muscle contractile function, reduce exercise-induced muscle fatigue, and facilitate postexercise recovery.     

Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe?

How to cite this article: Karim HMR, Esquinas AM. Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe? Indian J Crit Care Med 2022;26(10):1161.     

Less-Than-Standard Treatment in Rectal Cancer Patients: Which Patients Are at Risk?

ObjectiveGuidelines recommend that patients with non-metastatic rectal cancer receive surgery and adjuvant chemotherapy and/or radiation therapy (XRT) after surgery (especially if stage II and III). Studies reported that 90% of stage II and III patients received surgery, and 70% received adjuvant treatment. In states where socioeconomics and limited medical resources may hinder treatment, cancer care is understudied. The objective is to describe initiation and completion of rectal cancer treatment in Alabama.MethodsMedicare claims were obtained for 675 stage I to III rectal cancer patients diagnosed in 1999–2003, enrolled in fee-for-service Medicare, and with at least 9 months of follow-up. Logistic regressions were used to identify significant differences by sex, age, and race in the likelihood of initiating treatment and receiving an incomplete course of chemotherapy or XRT (< 120 days of chemotherapy and < 28 days of XRT).ResultsOverall, 90% received surgery, of which 43% received some adjuvant treatment. Among stage II to III patients, 58.8% received adjuvant treatment. Except for patients aged 75 years and greater being less likely to start chemotherapy, there were no significant differences in initiation by age, sex, and race. Depending on concurrent administration of chemotherapy and XRT, 29% to 35% received incomplete chemotherapy, and 16% to 23% incomplete XRT. Women were more likely to have incomplete chemotherapy than men.ConclusionsAdjuvant treatment was less than reported in previous studies. Treatment initiation and completion did not differ across demographic factors. Future studies should explore reasons why older rectal cancer patients in Alabama are less likely to receive recommended treatment.     

The Relevance of Fatalism in the Study of Latinas’ Cancer Screening Behavior: A Systematic Review of the Literature

Background  

Fatalism has been identified as a dominant belief among Latinos and is believed to act as a barrier to cancer prevention. However, controversy exists over the utility of the construct in explaining health disparities experienced by disadvantaged populations above the influence of structural barriers such as low socioeconomic status (SES) and limited access to health care.     

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients’ waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95 %) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.     

Artificial Intelligence-driven Digital Cytology-based Cervical Cancer Screening: Is the Time Ripe to Adopt This Disruptive Technology in Resource-constrained Settings? A Literature Review

Journal of Digital Imaging - Cervical cancer is still a public health scourge in the developing countries due to the lack of organized screening programs. Though liquid-based cytology methods...     

Uncovering Outcome Disparities of β2 Adrenergic Agonists in Blacks: A Systematic Review

PurposeOutcome differences driven by variation in Blacks' biologic response to treatment may contribute to persistent racial disparities in asthma morbidity and mortality. This review assessed systematic variation in β₂ agonist treatment outcomes among Blacks compared to other groups.MethodsWe conducted a systematic review of studies reporting differential response to β₂ agonists among Blacks, including studies identifying pharmacogenetic variants.ResultsOf 3158 papers, 20 compared safety or efficacy of β₂ agonists among Blacks as compared with other subgroups. Six papers evaluating efficacy of short-acting β₂ agonists (SABA) found similar or improved results among Blacks compared with other groups, while one small study found reduced response to SABA therapy among Blacks. Reports of safety and efficacy of long-acting β₂ agonists (LABA) indicated similar results among Blacks in four papers, while four reports found reduced safety among Blacks, as compared with other groups. Four papers assessed genomic variation and relative treatment response in Blacks, with two finding significant effects of the p.Arg16Gly variant in ADRB2 on β₂ agonist response and one finding significant gene-gene IL6/IL6R interaction effects on albuterol response.ConclusionsEvidence suggests the potential for differences in β₂ agonist outcomes among Blacks compared with other groups. This literature, however, remains small and significantly underpowered for substantive conclusions. There are notable opportunities for adequately-powered investigations exploring safety and efficacy of β₂ agonists among Blacks, including pharmacogenomic modifiers of response.     

Does Regular Breakfast Cereal Consumption Help Children and Adolescents Stay Slimmer? A Systematic Review and Meta-Analysis

ObjectiveTo review systematically the evidence on breakfast cereal consumption and obesity in children and adolescents and assess whether the regular consumption of breakfast cereals could help to prevent excessive weight gain.MethodsA systematic review and meta-analysis of studies relating breakfast cereal consumption to BMI, BMI z-scores and prevalence of obesity as the outcomes.Results14 papers met the inclusion criteria. The computed effect size for mean BMI between high consumers and low or non-consumers over all 25 study subgroups was −1.13 kg/m² (95% CI −0.81, −1.46, p ℋ 0.0001) in the random effects model, which is equivalent to a standardised mean difference of 0.24. Adjustment for age and publication bias attenuated the effect sizes somewhat but they remained statistically significant. The prevalence and risk of overweight was lower in children and adolescents who consume breakfast cereals regularly compared to those who consume them infrequently. Energy intakes tended to be higher in regular breakfast cereal consumers.ConclusionOverall, the evidence reviewed is suggestive that regular consumption of breakfast cereals results in a lower BMI and a reduced likelihood of being overweight in children and adolescents. However, more evidence from long-term trials and investigations into mechanisms is needed to eliminate possible confounding factors and determine causality.Key Words: Breakfast cereals, Obesity, Prevention, Children, Adolescents     

The Thomsen-Friedenreich Antigen and αGal-specific Human IgG Glycoforms: Concanavalin A Reactivity and Relation to Survival of Cancer Patients

Glycan structures of IgG strongly influence the affinity for Fcγ receptors and antibody effector functions. However, no particular attention has been paid yet to the glycosylation of tumor antigen-specific IgG. The objectives of this study were (i) to investigate the concanavalin A lectin (ConA) reactivity of human anti-Thomsen-Friedenreich (TF) and anti-αGal specific IgG in gastric cancer patients and healthy controls and (ii) to evaluate whether the ConA-reactivity of anti-TF and anti-αGal specific IgG is associated with the survival rate of patients with cancer. Total IgG was purified from the sera of patients with gastric cancer and healthy blood donors. The anti-TF and anti-αGal glycotope specific IgG were detected with ELISA using synthetic saccharide-polyacrylamide conjugates as antigen. In parallel plate, the ConA reactivity of the anti-TF or anti-αGal IgG was determined and the ConA index was calculated. Results show that serum anti-TF specific IgG antibodies of patients with cancer contain significantly higher content of ConA positive IgG glycoform compared to IgG of controls. No correlation between the ConA reactivity of anti-TF IgG and anti-αGal IgG was observed. High level of anti-TF IgG ConA reactivity was associated with a significantly lower survival rate of patients with gastric cancer.     

Effects of Ganopoly® (A Ganoderma lucidum Polysaccharide Extract) on the Immune Functions in Advanced‐Stage Cancer Patients

Preclinical studies have established that the Ganoderma lucidum polysaccharide (GLPS) fractions have potent anti‐tumor activity, which has been associated with the immuno‐stimulating effects of GLPS. However, it is unclear whether GLPS has immuno‐modulating effects in humans in vivo. This study aimed to investigate the effects of Ganopoly^®, the polysaccharides fractions extracted from G. lucidum, on the immune function of advanced‐stage cancer patients. Thirty‐four advance‐stage cancer patients were entered onto this study, and treated with 1800 mg Ganopoly^®, three times daily orally before meals for 12 weeks. Immune parameters (cytokines, T cell subsets, mitotic response to phytohemagglutinin (PHA) and natural killer (NK) activity) were compared between baseline and after 12‐week treatment. Thirty patients are assessable for their immune functions. Treatment of Ganopoly^® for 12 weeks resulted in a significant (P < 0.05) increase in the mean plasma concentrations of interleukin (IL‐2), IL‐6, and interferon (IFN)‐γ, whereas the levels of IL‐1 and tumor necrosis factor (TNF‐α) were significantly (P < 0.05) decreased. A marked variability among patients with advanced‐stage cancer was observed in the numbers of each lymphocyte subset at baseline. The mean absolute number of CD56⁺ cells was significantly (P < 0.05) increased after 12‐week treatment of Ganopoly^®, whereas the numbers of CD3⁺, CD4⁺, and CD8⁺ were just marginally increased compared to baseline levels, with the CD4:CD8 T cell ratios unchanged. PHA responses after 12‐week treatment with Ganopoly^® were enhanced in most patients, when compared to pretreatment baselines (P < 0.05). In addition, Ganopoly® treatment resulted in a significant increase (P < 0.05) in the mean NK activity compared to baselines (34.5 ± 11.8% vs 26.6 ± 8.3%). The present study indicates that Ganopoly^® enhanced the immune responses in patients with advanced‐stage cancer. Clinical evaluations of response and toxicity are ongoing.