Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies

Purpose: Understanding barriers and facilitators of physical activity participation in persons living with HIV/AIDS is an essential first step in order to devise effective interventions. The present review provides a systematic quantitative review of the physical activity correlates in people with HIV/AIDS.

Methods: Major electronic databases were searched till August 2016. Keywords included “physical activity” or “exercise” or “sports” and “AIDS” or “HIV”.

Results: Out of 55 correlates from 45 studies (N?=?13,167; mean age range?=?30.5–58.3?years; 63.2% male) five consistent (i.e., reported in four or more studies) correlates were identified. Lower levels of physical activity were consistently associated with older age (6/10 studies), a lower educational level (6/7), a lower number of CD4 cells/μl (7/11), exposure to antiviral therapy (4/6), and the presence of lipodystrophy (4/4). Other important barriers were the presence of bodily pain (2/2), depression (3/3), and opportunistic infections (3/4). Facilitators were a higher cardiorespiratory fitness level (3/3), a higher self-efficacy (2/2), more perceived benefits (2/2), and a better health motivation (3/3).

Conclusions: The current review has elucidated that participation in physical activity by people with HIV/AIDS is associated with a range of complex factors which should be considered in rehabilitation programs.

• Implications for Rehabilitation

• Health care professionals should consider HIV-related bodily pain and feelings of depression when assisting people living with HIV in inititiating and maintaining an active lifestyle.

• Interventions to improve self-efficacy and motivation, and to help people living with HIV in understanding the benefits of exercise, may encourage greater participation.

     

Global physical activity levels among people living with HIV: a systematic review and meta-analysis

Purpose: It is unclear how much physical activity people living with HIV (PLWH) engage in. We conducted a meta-analysis to investigate physical activity levels and its predictors in PLWH.

Methods: PubMed, PsycARTICLES, and CINAHL Plus were searched by two independent reviewers from inception till 1 April 2016 using the keywords: “HIV” OR “AIDS” AND “physical activity” OR “exercise” OR “sports”. A random effects meta-analysis was conducted.

Results: Across 24 studies including 34 physical activity levels there were 3780 (2471♂) PLWH (mean age range: 37–58 years). PLWH spent 98.9 (95%CI?=?64.8–133.1) minutes per day being physically active which is lower than in most other populations with chronic diseases. 50.7% (95%CI?=?39.3–62%) (n?=?2052) of PLWH complied with the physical activity guidelines of 150?min moderate intensity physical activity per week. The number of steps walked per day in 252 PLWH was 5899 (95%CI?=?5678–6418), which is below the 10,000 steps per day recommendation.

Conclusions: Our data demonstrate that a considerable proportion of PLWH are insufficiently physically active. Future lifestyle interventions specifically targeting the prevention of physical inactivity in PLWH are warranted.

• Implications for Rehabilitation

• Many people living with HIV do not comply with general health recommendations.

• Physical activity counseling should be key in the rehabilitation of people living with HIV.

     

Dietary Assessment on a Mobile Phone Using Image Processing and Pattern Recognition Techniques: Algorithm Design and System Prototyping

Dietary assessment, while traditionally based on pen-and-paper, is rapidly moving towards automatic approaches. This study describes an Australian automatic food record method and its prototype for dietary assessment via the use of a mobile phone and techniques of image processing and pattern recognition. Common visual features including scale invariant feature transformation (SIFT), local binary patterns (LBP), and colour are used for describing food images. The popular bag-of-words (BoW) model is employed for recognizing the images taken by a mobile phone for dietary assessment. Technical details are provided together with discussions on the issues and future work.     

Multicenter registry to evaluate the efficacy of the NIROYAL stent in de novo or restenotic coronary stenosis

The purpose of this registry was to document the safety and efficacy of elective deployment of the NIROYAL stent (Boston Scientific SCIMED, Maple Grove, Minnesota) in coronary arteries. This was a prospective, multi-center international registry. NIROYAL stents (9, 16, 25 and 32 mm-long) were manually crimped onto coronary balloons and deployed in de novo or restenotic lesions in 165 male and female patients with angina pectoris and a reference vessel diameter of 2.0-4.5 mm. Stent deployment was successful in 98.8% of the lesions. Mean percent diameter stenosis decreased from 83.5+/-10.8% to 2.7+/- 6.2% after intervention. The interventional procedure of the treatment site was successful in 97.6% of patients. At six-month clinical follow-up, 88.5% had event-free survival [i.e., did not experience a major adverse cardiac event (MACE)] and 95.2% had no anginal symptoms. Furthermore, 87.3% of the patients were free of target vessel failure (defined as a composite of acute procedural failure, target vessel revascularization, myocardial infarction or death at six months). Only three MACE were observed within the first 30 days after stent implantation. A low left ventricular ejection fraction and the percentage stenosis pre-procedure were identified as statistically significant (p<0.05) predictive factors for MACE. The incidences of MACE and target vessel failure after six months follow-up were lower than that seen in other studies, and target lesion revascularization rates were low.     

The patient experience of radiotherapy for breast cancer: A qualitative investigation as part of the SuPPORT 4 All study

IntroductionBreast cancer is a global health problem with 2.09 million cases of breast cancer diagnosed worldwide in 2018. With an increase in breast cancer survival attention has now focussed on the impact treatment side effects can have on the quality of life for women during survivorship. The aim of the SuPPORT 4 All project is to develop a support bra for use during radiotherapy, that can reduce normal tissue toxicity (for women with larger breasts) and provide accuracy, dignity and modesty for all women. The first stage of the project involved a co-design process to understand the current patient experience where no support bra or modesty device is used.MethodA participatory co-design methodology was adopted. Workshops were held with patient representatives (n = 9) to seek understanding of experience during radiotherapy; a total of three workshops over 4 h. The workshops were audio recorded and framework analysis was adopted to identify key patient experiences.ResultsTwelve categories and twenty-six sub categories were identified specific to patient experience. Patient concerns focussed on information provision, Healthcare Practitioner (HCP) knowledge of breast lymphoedema, lack of choice, experiences of being naked, and feelings of disempowerment.ConclusionsA number of areas were identified that had negative effects on overall patient experience.Implications for practicePractitioners should consider patient dignity when configuring services to support patient needs regarding undressing, outside or inside the linear accelerator room. Additionally, practitioners should have an understanding of the impact permanent tattoos may have on some patients’ wellbeing and the impact that breast lymphoedema has on patient quality of life. Practitioners should also consider methods to encourage patient empowerment during radiotherapy; supporting patient self-monitoring of side-effects may be one way to facilitate this.     

Identification and Quantification of Oligodendrocyte Precursor Cells in Multiple System Atrophy,Progressive Supranuclear Palsy and Parkinson's Disease

Multiple system atrophy is a neurodegenerative disorder characterized pathologically by abnormal accumulations of α‐synuclein in the cytoplasm of oligodendrocytes, which are termed glial cytoplasmic inclusions (GCIs). Oligodendrocytes are responsible for myelinating axons and providing neurotrophic support, but in MSA, myelin loss, axonal loss and gliosis are consistent features suggesting that GCIs play a central role in disease pathogenesis. Oligodendroglial, myelin and axonal degeneration are also features of multiple sclerosis (MS) in which recent studies have highlighted the robust remyelination capacity of the central nervous system (CNS). The cells responsible for remyelination are called oligodendroglial precursor cells (OPCs). In this study, we investigated the role of OPCs in the pathogenesis of MSA and progressive supranuclear palsy (PSP), a neurodegenerative disease in which neuropathological changes include oligodendroglial inclusions composed of microtubule‐associated protein tau. Despite the lability of OPC‐specific antigens, we successfully identified OPCs and demonstrated that tau and α‐synuclein do not accumulate in OPCs. We also showed that the density of OPCs was increased in a white matter region of the MSA brain, which is also severely affected by GCIs and myelin degeneration. These findings raise the possibility that OPCs could be available to repair disease‐associated damage in MSA, consistent with their biological function.     

Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions

ObjectiveThis retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification.Material and methodsCT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the “defect body” method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis.ResultsA total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures – W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm² to 6.09 cm² for orbital floor and from 0.29 cm² to 5.43 cm² for medial wall fractures.The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm², W2(i) = 1.64 cm², W1(i)2(i) = 3.10 cm², W1(m) = 1.36 cm², W2(m) = 1.65 cm², W1(m)2(m) = 2.98 cm², W1 (im) = 3.35 cm², W1 (im) 2(i) = 4.63 cm², W1 (im)2(m) = 4.06 cm² and W1 (im)2 (im) = 7.16 cm².ConclusionThe AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.     

Stimulation of DNA polymerase by factors isolated from Novikoff hepatoma.

Extracts of Novikoff hepatoma cells contain factors capable of stimulating in vitro DNA synthesis several fold. The activity can be resolved into three separate protein peaks on DEAE-Sephadex. Two of these, factors II and III, have been purified and partially characterized. Both factors increase the initial rate of DNA synthesis and allow synthesis to proceed much longer. If either factor is added after synthesis by the DNA polymerase has reached a plateau, resumption of synthesis occurs. The factors appear to have different modes of action or sites of action since they show an additive effect even when a single one is used at saturating conditions. These factors are present in normal rat liver but at a concentration less than 5% of that found in the tumor cells. When tested with several highly purified DNA polymerases (DNA nucleotidyltransferase, EC 2.7.7.7), the factors show a much greater stimulation of homologous, non-mitochondrial enzymes (rat liver nuclear-, rat liver cytoplasmic-, or Novikoff-DNA polymerases) when compared with rat liver or calf liver mitochondrial-, Escherichia coli I-, or sea urchin nuclear-DNA polymerases. The mechanism of action of these factors is not known at present. No enzymatic activity has been associated with factor III. Highly purified, but not homogeneous, preparations of factor II contain low levels of endonuclease; it has not been established whether endonuclease is a contaminant or is responsible for the stimulating activity.     

Assessing coronary stenosis. Quantitative coronary angiography versus visual estimation from cine-film or pharmacological stress perfusion images

Visual judgment of stenosis severity from cine-film or single-photonemission computed tomographic dipyrida-mole perfusion imageswas compared to assessment of stenosis severity as measuredwith digital quantitative coronary angiography. Thirty patientswith angiographically verified single-vessel disease underwentdipyridamole thallium stress testing within 90 days of angiography. RESULTS: A percent diameter stenosis of 50%, a percent area stenosisof 75% and a stenotic flow reserve of <3·75 measuredby quantitative coronary angiography (CMS, version 1·1,Medis Inc.) corresponded to haemodynamically significant stenosisas evaluated by visual estimates from cine-film or perfusionimages. Quantitative coronary angiography percent diameter stenosis(51·2% ± 12·6%) correlated closely (r=0·74)but underestimated significantly visual assessment of stenosisseverity from cine-film (69·3% ±21·2% p=0·0001).However, quantitative coronary angiography percent area stenosis(74·7% ± 11·7%) more closely reflectedvisual estimates from cine-film (P=0·19). Quantitativecoronary angiography stenotic flow reserve showed the highestpositive and negative predictive value regarding visual estimatesfrom cine-film (88%, 86%) or perfusion images (88% 64%) followedby percent diameter stenosis (86% 75% 86% 56%) and percent areastenosis (87% 80% 87% 60%), respectively. CONCLUSION: Evaluation of coronary lesions by quantitative coronary angiographycorresponds closely with visual estimates from cine-film andhaemodynamic significance as evaluated by dipyridamole perfusionimages. (Eur Heart J 1996; 17: 1167–1174)