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In breast cancer survivors (BCS), the contemporaneous increase of sedentary time and reduction of physical activity (PA) requires early attention because it has negative consequences for their health. Aims of the study were to investigate: a) the correlations between PA, sedentarism, and health-related measures; b) the association between different patterns of daily activity and health-related outcomes. Two hundred and nineteen BCS (50.98 ± 6.28) were selected for this study. Psychological, anthropometric, endocrine, sleeping, and both daily sedentary time and PA variables were considered. Sedentarism and PA have opposite correlations with anthropometric variables, anxiety, depression, morning salivary cortisol, and sleeping characteristics. The first favors pathological values and the latter favors normal values. Regression tree analysis showed the impact of different daily sedentary time and PA combinations on the investigated variables and allowed the individualization of their optimal combination for health. Our results could be useful to healthcare providers and BCS. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the effects of weekly personal feedback, based on objectively measured physical activity, on daily sleep in breast cancer survivors (BCS) with those of an intervention that also included online supervised physical exercise sessions (OSPES). BCS benefiting from both personal feedback and OSPES (n = 24), from pre-lockdown (T0) to the first month (T1) of the national lockdown, experienced an increase in both total (p ≤ 0.001) and restorative (p ≤ 0.001) sleep time, inverting their trend from the first month of lockdown to its end (total sleeping time T1 vs. T2 0.01 ≤ p <.001, T1 vs. T3 p ≤ 0.001; restorative sleeping time T1 vs. T2 0.05 ≤ p <.01, T1 vs. T3 p ≤ 0.001). Supportive technology, together with the reception of weekly tailored advice and OSPES seems to improve both quality and quantity of sleep. [ABSTRACT FROM AUTHOR]

A new numerical method based on numerical homogenization and model order reduction is introduced for the solution of multiscale inverse problems. We consider a class of elliptic problems with highly oscillatory tensors that varies on a microscopic scale. We assume that the micro structure is known and seek to recover a macroscopic scalar parameterization of the microscale tensor (e.g., volume fraction). Departing from the full fine-scale model, which would require mesh resolution for the forward problem down to the finest scale, we solve the inverse problem for a coarse model obtained by numerical homogenization. The input data, i.e., measurement from the Dirichlet-to-Neumann map, are solely based on the original fine-scale model. Furthermore, reduced basis techniques are used to avoid computing effective coefficients for the forward solver at each integration point of the macroscopic mesh. Uniqueness and stability of the effective inverse problem is established based on standard assumptions for the fine-scale model, and a link to this latter model is established by means of G-convergence. A priori error estimates are established for our method. Numerical experiments illustrate the efficiency of the proposed scheme and confirm our theoretical findings. [ABSTRACT FROM AUTHOR]

The literature indicates that the plasma cortisol-to-dehydroepiandrosterone-sulfate (DHEA-S) ratio is a marker of health status after menopause, when a decline in both estrogen and DHEA-S and an increase in cortisol occur. An increase in the cortisol-to-DHEA-S ratio has been positively correlated with metabolic syndrome, all-cause mortality, cancer, and other diseases. The aim of this study was to investigate the effects of a walking program on the plasma cortisol-to-DHEA-S ratio in postmenopausal women. Fifty-one postmenopausal women participated in a 13-week supervised walking program, in the metropolitan area of Pescara (Italy), from June to September 2013. Participants were evaluated in April-May and September-October of the same year. The linear mixed model showed that the variation of the log10Cortisol-to-log10DHEA-S ratio was associated with the volume of exercise (p = .03). Participants having lower adherence to the walking program did not have a significantly modified log10Cortisol or log10DHEA-S, while those having the highest adherence had a significant reduction in log10Cortisol (p = .016) and a nearly significant increase in log10DHEA-S (p = .084). Walking training appeared to reduce the plasma log10Cortisol-to-log10DHEA-S ratio, although a minimum level of training was necessary to achieve this significant reduction. [ABSTRACT FROM AUTHOR]

Purpose: Physical exercise has been shown effective for bone health, across lifespan, if proper characteristics have been ensured during exercise prescription and conduction. The aim of our study was to verify if workout organization, in postmenopausal women, may have a central role in determining the entity of the osteogenic effect of a physical exercise program. Methods: Thirty-two postmenopausal women (mean age 59.35 ± 3.65 years) were eligible for the study. Plasma BAP and CTx-I were collected, and DEXA, anthropometry, dietary habits, and fitness tests have been ascertained before and after their participation in 12-week supervised workouts. One sub-group (TWs-s) was trained according to a traditional workout scheme, while the other sub-group (BBs-s) was trained following a bone-based scheme of exercise rotation. Results: BBs-s significantly increased BAP plasma values ( p = 0.004) and Six-Minute Walking Test result ( p < 0.001), while TWs-s not. Both the sub-groups significantly increased Flamingo Balance Test ( p = 0.05), Plank Position Test ( p < 0.001), Handgrip Test ( p = 0.004), Squat Test ( p < 0.001), and Arm Curl Test ( p < 0.001). Conclusions: When bone health is considered, the establishment of the right exercise order, in a circuit training workout, is very important, because it could amplify or delay mechanoreceptor desensitizing. The experimented bone-based scheme of exercise rotation seems able to furnish positive effects on bone, muscle, and aerobic fitness. [ABSTRACT FROM AUTHOR]

Purpose: The analysis of daily physical activity characteristics is an important starting point to favor the promotion of proper physical activity against obesity. The aim of our study was to characterize physical activity organization, among the different intensities and across age and ponderal status, to verify whether the normal-weight condition has the same physical activity characteristics across ages. Methods: We recruited 381 female participants; 100 were between 6 and 10 years old; 134 were between 35 and 54 years, and 147 were between 55 and 69 years. The body mass index of participants ranged from normal weight to obese. Daily physical activity was objectively recorded in the period between 15 June and 15 July, from 2011 to 2014. The effects of age, ponderal status, and their interaction on daily physical activity were studied. Results: Normal-weight children (NW-C) have higher daily METs and more vigorous physical activity than other sub-samples, while overweight and obese children (OW-C, O-C) have the same daily physical activity characteristics as normal-weight adults and older adults (NW-A, NW-OA). Conclusions: In female population, the intensity of daily physical activity is a distinctive characteristic of NW-C, while time engaged in moderate physical activity is a distinctive characteristic for NW-A and NW-OA. As OW-C and O-C have the same physical activity characteristics as NW-A and NW-OA, it is suggested that an age-related approach in the field of physical activity promotion should be developed. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) and cardiovascular (CV) disease share many risk factors associated with worse outcomes, in terms of cancer relapse, CV events, and quality of life (QoL), that could be counteracted by physical exercise (PE). We aimed to assess the impact of a 12-week differential PE protocol on cardiometabolic profile, QoL, CV- and BC-related long-term outcomes, and physical activity (PA) in a cohort of BC survivors (BCS) not treated with chemotherapy. Methods: 57 BCS participated in a 12-week PE protocol [aerobic exercise training (AET) or resistance exercise training (RET)]. Anthropometric and CV evaluation, health-related (HR)-QoL, daily PA, cortisol, and dehydroepiandrosterone sulfate (DHEA-S) levels were assessed before (T0) and after (T1) PE. We assessed BC and CV outcomes, HR-QoL, CV-QoL, and PA at the follow-up. Results: RET improved waist circumference, DHEA-S, cortisol/DHEA-S, systolic and mean blood pressure, and ventricular/arterial coupling; AET ameliorated sagittal abdomen diameter and pulse wave velocity. Regarding HR-QoL, physical function improved only in AET group. At a mean 34 ± 3.6-month follow-up, we documented no significant differences in CV-QoL, HR-QoL, and PA or CV and BC outcomes. Conclusions: AET and RET determine specific, positive adaptations on many parameters strongly related to CV risk, CV and BC outcomes, and QoL, and should be included in any cardio-oncology rehabilitation program. [ABSTRACT FROM AUTHOR]

Physical exercise is used for the promotion and maintenance of good health and for the improvement of physical fitness. Both endurance and resistance exercises are needed to carry out a complete training program. Because time may be a barrier to physical exercise practice, the aim of this study was to verify whether the order of execution of endurance and resistance exercises, in concurrent training, has different effects on the metabolic responses during recovery. Thirteen healthy women [24.40 (1.67) years, Mean (SD)] were investigated for energy expenditure (EE), oxygen consumption (VO2), ventilation (Ve), respiratory frequency (RF), proportion of oxygen in expired air (FeO2) and ratings of perceived exertion (RPE) both before and after three concurrent endurance and resistance trainings, carried out in different orders: endurance-resistance training (ERT), resistance-endurance training (RET) and alternating endurance-resistance training (AERT). AERT elicited a significantly greater increase of EE, VO2, and Ve and a greater decrease of FeO2. ERT elicited a lower increase of RPE. Acute post-exercise physiological responses to concurrent endurance and resistance physical exercise seem to depend on the order of execution of the two parts: among the selected protocols, AERT seems to elicit the best responses. [ABSTRACT FROM AUTHOR]

Pre-participation screening is very important for prescribing and practising exercise safely. The aim of this study was to investigate both ratings of perceived exertion (REP) and blood pressure responses in two different types of exercises with matching duration and indirectly determined working heart rate (HR). Participants were 23 male students, who were generally healthy but sedentary. The time course of their REP and blood pressure during a 50-minute work-out session on an arm crank ergometer and a cross trainer were compared. RM-ANOVA showed both a higher REP (p < 0.001) and diastolic blood pressure (DBP) (p < 0.001) response to the arm exercise that were shown significantly correlated (r = 0.883; p = 0.008). Linear regression analysis (p = 0.001) confirmed the ability to predict the time course of DBP by knowing the REP on the arm crank ergometer. Even if people use the recommended relative intensity, the HR method is not always safe for health without pre-participation screening because exercise characteristics can negatively influence physiological responses. The HR method could be substituted by the REP method. [ABSTRACT FROM AUTHOR]

Using the multi‐states (MuSt) theory framework, this study examined the interplay between self‐confidence, emotional arousal control, worry, concentration disruption, challenge and threat appraisals, psychobiosocial experiences, and self‐evaluated performance of medalist kickboxers involved in the WAKO World Kickboxing Championship 2021. Participants were 103 gold, silver, or bronze medalists (58 women and 45 men), aged 18–39 (M = 25.16 ± 4.54 years), who were contacted via email and social media and asked to fill an online survey 3 months after the event. According to the MuSt theory predictions, self‐confidence and emotional arousal control were positively related to challenge appraisal, functional psychobiosocial experiences, and self‐evaluated performance. Worry and concentration disruption were positively associated with threat appraisal, and negatively related to functional psychobiosocial experiences; concentration disruption was also negatively related to self‐evaluated performance. Results from path analysis revealed a positive indirect link from self‐confidence to self‐evaluated performance via challenge appraisal and psychobiosocial experiences. Negative indirect links from worry and concentration disruption to self‐evaluated performance through threat appraisal and psychobiosocial experiences were significant. A positive indirect effect from emotional arousal control to self‐evaluated performance via psychobiosocial experiences was also shown. The findings are discussed in light of the MuSt theory. Highlights: According to the multi‐states (MuSt) theory predictions, we observed that self‐confidence and emotional arousal control were positively related to challenge appraisal, functional psychobiosocial experiences, and self‐evaluated performance.We also showed that worry and concentration disruption were positively associated with threat appraisal, and negatively related to functional psychobiosocial experiences, with concentration disruption being also negatively related to self‐evaluated performance.We provide preliminary support to the multidimensional interplay between functional (i.e., self‐confidence and emotional arousal control) and dysfunctional (i.e., worry and concentration disruption) individual dispositions, challenge and threat appraisals, psychobiosocial experiences, and performance.We recommend that athletes adopt self‐regulation strategies, such as self‐talk, imagery, cognitive restructuring, mindfulness, and action monitoring to improve their self‐confidence, challenge appraisal, functional emotions, and ability to manage competitive pressure. [ABSTRACT FROM AUTHOR]

Nowadays, the necessity of having a cardioplegia circuit capable of being adapted in order to administer different types of cardioplegia is strategically fundamental, both for the perfusionist and for the cardiac surgeon. This allows to avoid cutting tubes, guarantees sterility and, most of all, limits the number of cardioplegia circuits for the different strategies of cardiac arrest. The novel "ReverseTWO cardioplegia circuit system" is the development of the precedent "Reverse system" where mainly the 4:1 and crystalloid cardioplegia were used, It has the advantage of allowing immediate change of cardioplegia set-up versus four types of cardioplegia technique, when the strategy is unexpectedly changed before the beginning of cardiopulmonary bypass (CPB), is safe and enables the perfusionist to use one single custom pack of cardioplegia. Two pediatric roller pumps are usually used in our centre for cardioplegia administration; they have a standardized calibration (the leading with ¼ inch and the follower with 1/8 inch) and the circuit consequently has two different tube diameters for the two different pumps. The presence in the circuit of two different shunts coupled with two different coloured clamps allows the immediate set-up for different cardioplegia administration techniques utilizing a colour-coding mechanism The aim of this manuscript is to present the new ReverseTWO Circuit. This novel system allows to administer four different cardioplegic solutions (4:1, 1:4, crystalloid, ematic) based on multiple tubes, which can be selectively clamped, identified through a color-coding method. The specificity of this circuit is the great versatility, which leads to numerous advantages, such as reduced risk of perfusion accident and reduced costs related not only to the purchase of different cardioplegia kits but also to the storage. https://youtu.be/ovJBE4ok2Ds [ABSTRACT FROM AUTHOR]

Aortic valve replacement still represents the gold standard treatment for severe symptomatic aortic stenosis. Sutureless bioprostheses have been so far developed to enhance the minimally invasive approach, resulting in a reduction of cross-clamp time. Even if the first implantation was carried out more than 10 years ago, some cases of valve degeneration treated with balloon-expandable valve-in-valve procedures have been previously described in the literature. Here, we present a case of early sutureless valve degeneration resulting in severe aortic regurgitation. After careful evaluation of the patient's comorbidities, a successful valve-in-valve was finally performed using a self-expandable transcatheter prosthesis. A wide discussion of the Heart Team decision-making process and of the technical aspects has been addressed. [ABSTRACT FROM AUTHOR]

Simple Summary: Only the two-third of athletes who undergo anterior cruciate ligament reconstruction (ACLR) return to their pre-injury level and to sports participation. The timing for a safe return to sports participation plays a crucial role in reducing reinjury risk, which implies sensitive and reliability neuromechanical assessments to understand whether the deficit or alteration in motor control persists. The changes following ACLR are considered neurophysiological dysfunctions and not a simple peripheral musculoskeletal injury, and, consequently, the brain activation that influences bilateral lower extremity function may have occurred and the neuromechanical alterations could affect not only the operated leg but also the contralateral leg. Our study investigated the maximal voluntary isometric contractions synchronised with surface electromyographic (sEMG) activity of the thigh muscles during unilateral and bilateral knee extension in individuals with ACLR. The results showed that asymmetries between the two lower limbs were found only during bilateral exertions. Therefore, bilateral exertions are essential to underline neuromechanical alteration following ACLR. These findings could be helpful to define guidelines of expected longitudinal adaptations to reduce asymmetries and optimize functional recovery. Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional–national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6–9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m2), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m2). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant (p > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally (p < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally (p < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally (p < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: Although outdoor water sport activities are gaining increasing attention for their therapeutic potential in the social and care management of populations with chronic diseases, these practices are currently underutilised. Moreover, the available body of literature on the topic has not been critically and comprehensively assessed yet. Aims: (1) To appraise the health effects of outdoor water sport activities for chronic disease populations; (2) to preliminarily assess the potential size and scope of the available research literature for this emerging field and identify potential gaps and avenues of development. Methods: A literature search was performed scanning PubMed (including MEDLINE), Physiotherapy Evidence Database (PEDro) and Scopus from inception to December 2021. A scoping review was carried out by appraising all the available evidence on outdoor water sport interventions specifically designed for therapeutic purposes for individuals with chronic disease. The quality score of each study was calculated with the Tool for the assEssment of Study qualiTy and reporting in Exercise (TESTEX) tool. Results: Fifteen studies (five RCTs, seven non-RCTs and three CTs with healthy subjects as controls) met the inclusion criteria and were assessed. Among the studies selected, two focused on canoa kayak, one on stand-up paddle, two on surfing, two on sailing activity, and eight on dragon boat padding. The median TESTEX score for study quality and reporting was 6/15, i.e., "very low" (range 5–8). Based on the qualitative analysis, the few individual studies that could be included reported generally positive results, ranging from improvements in antioxidant action and cardiovascular function for dragon boating, to beneficial effects on balance, postural control, and flexibility for on-water paddle board activities. Overall, outdoor water sport interventions were associated to higher rates of adherence than conventional trainings. Conclusions: Very low to low quality evidence from a limited set of pilot studies seems to suggest beneficial effects of outdoor water sports for chronic disease populations. However, such preliminary findings need to be replicated through large, high-quality RCTs to be conducted in target populations. Avenues of development, scoping directions and translational perspectives for this specific research field are proposed and discussed. [ABSTRACT FROM AUTHOR]

There is virtually an unlimited number of possible Tissue Microarray (TMA) applications in basic and clinical research and ultimately in diagnostics. However, to assess the functional importance of novel markers, researchers very often turn to cell line model systems. The appropriate choice of a cell line is often a difficult task, but the use of cell microarray (CMA) technology enables a quick screening of several markers in cells of different origins, mimicking a genomic-scale analysis. In order to improve the morphological evaluations of the CMA slides we harvested the cells by conventional trypsinization, mechanical scraping and cells grown on coverslips. We show that mechanical scraping is a good evaluation method since keeps the real morphology very similar to those grown on coverslips. Immunofluorescence images are of higher quality, facilitating the reading of the biomarker cellular and subcellular localization. Here, we describe CMA technology in stem cell research. [ABSTRACT FROM AUTHOR]

Background: This study aims at better defining the profile of patients with a complicated versus noncomplicated postoperative course following isolated tricuspid valve (TV) surgery to identify predictors of a favorable/unfavorable hospital outcome.Methods: All patients treated with isolated tricuspid surgery from March 1997 to January 2020 at our institution were retrospectively reviewed. Considering the complexity of most of these patients, a regular postoperative course was arbitrarily defined as a length-of-stay in intensive care unit less than 4 days and/or postoperative length-of-stay less than 10days. Patients were therefore divided accordingly in two groups.Results: One hundred and seventy-two patients were considered, among whom 97 (56.3%) had a regular (REG) and 75 (43.6%) a non-regular (NEG) postoperative course. The latter had worse baseline clinical and echocardiographic characteristics, with higher rate of renal insufficiency, previous heart failure hospitalizations, cardiac operations, and right ventricular dysfunction. NEG patients more frequently needed tricuspid replacement and experienced a greater number of complications (p < .001) and higher in-hospital mortality (13% vs. 0%, p < .001). The majority of these complications were related to more advanced stage of the tricuspid disease. Among most important predictors of a negative outcome univariate analysis identified chronic kidney disease, ascites, previous right heart failure hospitalizations, right ventricular dysfunction, previous cardiac surgeries, TV replacement and higher MELD scores. At multivariate analysis, liver enzymes and diuretics' dose were predictors of complicated postoperative course.Conclusion: In isolated TV surgery a complicated postoperative course is observed in patients with more advanced right heart failure and organ damage. Earlier surgical referral is associated to excellent outcomes and should be recommended. [ABSTRACT FROM AUTHOR]

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed.Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (±mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyzed. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4 ± 3.9 years, max: 16.4). Kaplan-Meier estimates were employed to analyze long-term survival. Cumulative incidence function (CIF) for time to reoperation, recurrence of aortic regurgitation (AR) ≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed.Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4 ± 2.5%, 95% confidence interval (CI: 83.16-99.63). At follow-up there were no cases of aortic root surgery whereas three patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6 ± 2.5%, 95% CI [0.20-11.53]. At follow-up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR more than 2+/4+ was 5.1 ± 4.98% and of AS more than moderate 6.9 ± 3.8%.Conclusions: In our study mild to moderate regurgitation of a BAV did not do significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement. [ABSTRACT FROM AUTHOR]

The aim of this meta-analysis was to aggregate data from studies investigating the risk factors associated with low back pain (LBP) in competitive gymnasts. Four databases were searched and studies reporting demographics, anthropometrics, functional, psychosocial and gymnastics-practice variables in competitive gymnasts with and without LBP were included. For continuous data, the weighted mean difference (MD) and confidence interval (95% CI) were calculated, while odds or risk ratio (OR, RR) were calculated for dichotomous data. Meta-analysis of six cross-sectional studies involving 284 competitive female gymnasts revealed that artistic were more likely to report LBP compared to rhythmic gymnasts (RR 1.4, 95% CI 1.04–2.0, Z=2.2, p=0.03). Data pooling revealed that age (MD 1.5 years, 95% CI 0.4–2.5, p=0.005) and body weight (MD 3.5 kg, 95% CI 0.1–6.8, p=0.04) were significantly higher in gymnasts with LBP compared to those without. Subgroup-analyses confirmed these differences in artistic but not in rhythmic gymnasts. Moreover, artistic gymnasts with LBP tended to display longer gymnastics-practice history (p=0.09) compared to those without. Increased age, body weight and, to a lesser extent, longer gymnastics-practice appear to differentiate artistic gymnasts with LBP from those without; conversely, these potential risk factors seem less relevant for rhythmic gymnasts. [ABSTRACT FROM AUTHOR]

Background: End-stage renal disease patients living with a kidney transplant (KT) often present with frailty, functional disability, and mobility impairments that may result in a high risk of falls. Postural balance and muscle strength are implicated in the etiology of falls in the geriatric population, and both may be impaired in KT patients.Research Question: We conducted a cross-sectional investigation to estimate the prevalence of falls, as well as to explore the association between postural balance, muscle strength and history of falls in end-stage renal disease patients living with a KT.Methods: Fifty-nine prevalent KT patients (age = 53.2 ± 11 years) were enrolled in this cross-sectional study. Participants were classified as fallers/non-fallers and underwent an objectively-measured assessment of postural balance on a stabilometric platform in eyes open (EO), eyes closed (EC), and dual-task (DT) conditions. Center of pressure (CoP) variables were taken for the analysis. In addition, participants underwent isometric (IM) and isokinetic (IK) assessments of lower limb muscle strength on a multi-joint evaluation system.Results: Thirty-four percent of the study participants reported at least one fall in the previous 12 months. In logistic regression analysis, CoP velocity in EO (OR: 1.23, 95 % CI: 1.06-1.43, p = .007), and IK ankle dorsiflexion strength (OR: 0.87, 95 % CI: 0.77-0.99, p = .034) were independently associated with increased odds of falling.Significance: This cross-sectional study indicates that patients living with a KT presented with a prevalence of falls indicative of a high risk of falling. Postural balance and muscle strength are exercise-modifiable factors and further research is warranted to establish to what extent these measures may be implicated in the etiology of falling in this patient group. [ABSTRACT FROM AUTHOR]

Mycobacterium chimaera infections have mainly been associated with the heater-cooler unit (HCU) and, ultimately, linked to contaminated aerosols in the operation room. The contamination status of HCUs seems to be influenced by the maintenance, therefore, according to the manufacturer's recommendations, peracetic acid (Puristeril) was introduced to increase HCU cleaning and disinfection protocol maintenance. Aerosol dispersion from Puristeril during maintenance can cause adverse effects to nearby workers. We aim to describe our technique to reduce the impact of Puristeril on operating room staff and to limit dispersion of its aerosol in the environment by performing the cleaning procedure through a closed circuit. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to summarize and analyze the effects of Nordic Walking on physical fitness, body composition, and quality of life in the elderly. Keyword "Nordic Walking" associated with "elderly" AND/OR "aging" AND/OR "old subjects" AND/OR "aged" AND/OR "older adults" were used in the online database MEDLINE, Embase, PubMed, Scopus, PsycINFO, and SPORTDiscus. Only studies written in English language and published in peer-reviewed journals were considered. A meta-analysis was performed and effect sizes calculated. Fifteen studies were identified; age of participants ranged from 60 to 92 years old. Comparing with a sedentary group, effect sizes showed that Nordic Walking was able to improve dynamic balance (0.30), functional balance (0.62), muscle strength of upper (0.66) and lower limbs (0.43), aerobic capacity (0.92), cardiovascular outcomes (0.23), body composition (0.30), and lipid profile (0.67). It seemed that Nordic Walking had a negative effect on static balance (-0.72). Comparing with a walking (alone) training, effect sizes showed that Nordic Walking improved the dynamic balance (0.30), flexibility of the lower body (0.47), and quality of life (0.53). Walking training was more effective in improving aerobic capacity (-0.21). Comparing Nordic Walking with resistance training, effect sizes showed that Nordic Walking improved dynamic balance (0.33), muscle strength of the lower body (0.39), aerobic capacity (0.75), flexibility of the upper body (0.41), and the quality of life (0.93). Nordic Walking can be considered as a safe and accessible form of aerobic exercise for the elderly population, able to improve cardiovascular outcomes, muscle strength, balance ability, and quality of life. [ABSTRACT FROM AUTHOR]

Background: Despite the large number of studies and reviews available, the evidence regarding the policy determinants of physical activity (PA) is inconclusive. This umbrella systematic literature review (SLR) summarizes the current evidence on the policy determinants of PA across the life course, by pooling the results of the available SLRs and meta-analyses (MAs). Methods: A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus and SPORTDiscus databases up to April 2016. SLRs and MAs of observational studies investigating the association between policy determinants of PA and having PA as outcome were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence and the methodological quality. Results: Fourteen reviews on 27 policy determinants of PA were eligible for this umbrella SLR. The majority of the reviews were of moderate quality. Among children, a clear association between time spent outdoors and PA emerged. Among adults, working hours were negatively associated with PA, though evidence was limited. At the population level, community- and street-scale urban design and land use policies were found to positively support PA levels, but levels of evidences were low. Conclusions: With this umbrella SLR the policy determinants of PA at individual-level and population-level have been summarized and assessed. None of the investigated policy determinants had a convincing level of evidence, and very few had a probable level of evidence. Further research is needed, preferably by using prospective study designs, standardized definitions of PA and objective measurement of PA. [ABSTRACT FROM AUTHOR]

Background: To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course. Methods: Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus were searched for systematic literature reviews and meta-analyses of observational studies investigating the association between socioeconomic determinants of PA and PA itself (from January 2004 to September 2017). Data extraction evaluated the importance of determinants, strength of evidence, and methodological quality of the selected papers. The full protocol is available from PROSPERO (PROSPERO2014:CRD42015010616). Results: Nineteen reviews were included. Moderate methodological quality emerged. For adults, convincing evidence supports a relationship between PA and socioeconomic status (SES), especially in relation to leisure time (positive relationship) and occupational PA (negative relationship). Conversely, no association between PA and SES or parental SES was found for pre-school, school-aged children and adolescents. Conclusions: Available evidence on the socioeconomic determinants of PA behaviour across the life course is probable (shows fairly consistent associations) at best. While some evidence is available for adults, less was available for youth. This is mainly due to a limited quantity of primary studies, weak research designs and lack of accuracy in the PA and SES assessment methods employed. Further PA domain specific studies using longitudinal design and clear measures of SES and PA assessment are required. [ABSTRACT FROM AUTHOR]

Background Chemotherapy-induced peripheral neuropathy (CIPN) is the most common neurological and clinically relevant side effect of many commonly used chemotherapeutic agents. Moreover, little effort has been done to investigate the potentially beneficial effects of specific exercises to counteract the CIPN symptoms. Objective This document aims to summarize and analyze systematically the current body of evidence about the effects of specific exercise protocols on CIPN symptoms, balance control, physical function and quality of life in patients with CIPN. Literature survey Specific terms were identified for the literature research in MEDLINE, Scopus, Bandolier, PEDro, and Web of Science. Methodology Five manuscripts were considered eligible for this review. Quality appraisal distinguished two studies as high quality investigations while three with low quality. Results were summarized in the following domains: “CIPN symptoms”, “Static balance control”, “Dynamic balance control”, “Quality of life and Physical function”. Synthesis Significant improvements were detected on postural control. Additionally, patients’ quality of life and independence were found ameliorated after exercise sessions. Combined exercise protocols including endurance, strength and sensorimotor training showed larger improvements. Conclusions This systematic review comes from a highly selected but small source of data. Nevertheless, specific exercise for cancer patients undergoing chemotherapy with CIPN symptoms should be recommended since these interventions appeared as feasible and have been demonstrated as useful tools to counteract some of the limitations due to chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: Regular physical activity (PA) reduces the risk of disease and premature death. Knowing factors associated with PA might help reducing the disease and economic burden caused by low activity. Studies suggest that socio-cultural factors may affect PA, but systematic overviews of findings across the life course are scarce. This umbrella systematic literature review (SLR) summarizes and evaluates available evidence on socio-cultural determinants of PA in children, adolescents, and adults. Methods: This manuscript was drafted following the recommendations of the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses' (PRISMA) checklist. The MEDLINE, Web of Science, Scopus, and SPORTDiscus databases were searched for SLRs and meta-analyses (MAs) on observational studies published in English that assessed PA determinants between January 2004 and April 2016. The methodological quality was assessed and relevant information on socio-cultural determinants and any associations with PA was extracted. The available evidence was evaluated based on the importance of potential determinants and the strength of the evidence. Results: Twenty SLRs and three MAs encompassing 657 eligible primary studies investigated potential socio-cultural PA determinants, with predominantly moderate methodological quality. Twenty-nine potential PA determinants were identified that were primarily assessed in children and adolescents and investigated the micro-environmental home/household level. We found probable evidence that receiving encouragement from significant others and having a companion for PA were associated with higher PA in children and adolescents, and that parental marital status (living with partner) and experiencing parental modeling were not associated with PA in children. Evidence for the other potential determinants was limited, suggestive, or non-conclusive. In adults, quantitative and conclusive data were scarce. Conclusions: A substantial number of SLRs and MAs investigating potential socio-cultural determinants of PA were identified. Our data suggest that receiving social support from significant others may increase PA levels in children and adolescents, whereas parental marital status is not a determinant in children. Evidence for other potential determinants was limited. This was mainly due to inconsistencies in results on potential socio-cultural determinants of PA across reviews and studies. Trial registrations: This umbrella SLR was recorded on PROSPERO (Record ID: CRD42015010616). [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the cardiometabolic responses (VO and HR) and rate of perceived exertion (RPE) of walking, at the same percentage of heart rate reserve (HR) plus resting heart rate (HR), on a nonmotorized aquatic treadmill and on a land-based motorized treadmill, in healthy older adults. Methods: Eighteen healthy older adults, all men, were required to perform two trials in random order, one on an underwater nonmotorized treadmill and the other on land motorized treadmill. Each trial consisted in a 20-min walk. The first 10 min carried out at 40% of HR + HR, and the second 10 min at 60% of HR + HR. The HR and HR percentages were calculated on the basis of a maximal treadmill test on land. Results: HR, VO, VE, and RPE outcomes were significantly different between the two executive frequencies, but not between the two environment conditions. The results indicate that cardiometabolic responses and rate of perceived exertion are similar during a walk on a land motorized treadmill and on a nonmotorized aquatic treadmill, at the same percentage of heart rate reserve. Conclusions: The present investigation indicates that data of land maximal exercise test can be used to prescribe water aerobic exercise. [ABSTRACT FROM AUTHOR]

Low levels of physical activity (PA) are reported to contribute to the occurrence of non-communicable diseases over the life course. Although psychological factors have been identified as an important category concerning PA behavior, knowledge on psychological determinants of PA is still inconclusive. Therefore, the aim of this umbrella systematic literature review (SLR) was to summarize and synthesize the scientific evidence on psychological determinants of PA behavior across the life course. A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January 2004 to April 2016. SLRs and meta-analyses (MAs) of observational studies investigating the association of psychological variables and PA were considered eligible. Extracted data were evaluated based on importance of determinants, strength of evidence, and methodological quality. The full protocol is available from PROSPERO (Record ID: CRD42015010616). Twenty reviews (14 SLRs and 6 MAs), mostly of moderate methodological quality, were found eligible. Convincing evidence was found for self-efficacy (positive association with PA) in children and adolescents, and stress (negative association with PA) regardless of age. Most of the evidence revealing an association between psychological determinants and PA is probable and limited, mainly due to differences in the definition of PA and of psychological determinants across reviews. Thus, scholars are urged to reach a consensus on clear definitions of relevant psychological determinants of PA, subsuming cultural biases and allowing the possibility to obtain clear interpretations and generalizability of findings. Finally, most psychological determinants should be considered within a larger framework of other multi-level determinants that may interact or mediate some of the effects. [ABSTRACT FROM AUTHOR]

Background: Participation in regular physical activity is associated with a multitude of health benefits across the life course. However, many people fail to meet PA recommendations. Despite a plethora of studies, the evidence regarding the environmental (physical) determinants of physical activity remains inconclusive. Objective: To identify the physical environmental determinants that influence PA across the life course. Methods: An online systematic literature search was conducted using MEDLINE, ISI Web of Science, Scopus and SPORTDiscus. The search was limited to studies published in English (January 2004 to April 2016). Only systematic literature reviews (SLRs) and meta-analyses (MAs) of observational studies, that investigated the association between physical determinants and physical activity outcomes, were eligible for inclusion. The extracted data were assessed on the importance of determinants, strength of evidence and methodological quality. Results: The literature search identified 28 SLRs and 3 MAs on 67 physical environmental characteristics potentially related to physical activity that were eligible for inclusion. Among preschool children, a positive association was reported between availability of backyard space and outdoor toys/equipment in the home and overall physical activity. The availability of physical activity programs and equipment within schools, and neighbourhood features such as pedestrian and cyclist safety structure were positively associated with physical activity in children and adolescents. Negative street characteristics, for example, lack of sidewalks and streetlights, were negatively associated with physical activity in adults. Inconsistent associations were reported for the majority of reviewed determinants in adults. Conclusion: This umbrella SLR provided a comprehensive overview of the physical environment determinants of physical activity across the life course and has highlighted, particularly amongst youth, a number of key determinants that may be associated with overall physical activity. Given the limited evidence drawn mostly from cross-sectional studies, longitudinal studies are needed to further explore these associations. Registration: PROSPERO [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching. METHODS: Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m2, female 62.9% vs sutured: BSA 1.77 ± 0.15 m2, female 62.9%). RESULTS: After matching, the indexed effective orifice area was 1.50 ± 0.18 cm2/m2 and 0.81 ± 0.19 cm2/m2 in the sutureless and the sutured group, respectively (P < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis (n = 62). In the sutured group (n = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% (n = 26) and severe in 19.4% (n = 12) (P < 0.001). CONCLUSIONS: The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM. [ABSTRACT FROM AUTHOR]

Background: Low levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course. Methods: A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616). Results: Seventeen reviews on 35 behavioral determinants of PA were eligible for this umbrella SLR. Regardless of age, the most investigated determinants were those related with 'screen use' and 'smoking'. For youth, probable positive evidence emerged for 'previous PA' and 'independent mobility and active transport' among children and adolescents. For the adult population, 'transition to university' and 'pregnancy/having a child' showed probable negative associations. Conclusions: Although the majority of the evidence was limited and most of the determinants were not associated with PA, this umbrella SLR provided a comprehensive overview of the associations between behavioral determinants and PA. Youth should be physically active in the early years and increase active transportation to/from school, independent mobility, and 'free-range activities' without adult supervision, whilst adult PA behaviors are mostly influenced by the life events. Finally, more research is needed that incorporates prospective study designs, standardized definitions of PA, objective measurement methods of PA assessment, and the use of interactionist and mediational approaches for the evaluation of different behavioral determinants influencing PA behaviors. [ABSTRACT FROM AUTHOR]

Background: Lower extremity muscle mass, strength, power, and physical performance are critical determinants of independent functioning in later life. Isokinetic dynamometers are becoming very common in assessing different features of muscle strength, in both research and clinical practice; however, reliability studies are still needed to support the extended use of those devices. Objective: The purpose of this study is to assess the test-retest reliability of knee and ankle isokinetic and isometric strength testing protocols in a sample of older healthy subjects, using a new and untested isokinetic multi-joint evaluation system. Methods: Sixteen male and fourteen female older adults (mean age 65.2 ± 4.6 years) were assessed in two testing sessions. Each participant performed a randomized testing procedure that includes different isometric and isokinetic tests for knee and ankle joints. Results: All participants concluded the trial safety and no subject reported any discomfort throughout the overall assessment. Coefficients of correlation between measures were calculated showing moderate to strong effects among all test- retest assessments and paired-sample t test showed only one significant difference (p<0.05) in the maximal isokinetic bilateral knee flexion torque. Conclusions: The multi-joint evaluation system for the assessment of knee and ankle isokinetic and isometric strength provided reliable test- retest measures in healthy older adults. Level of evidence: Ib. [ABSTRACT FROM AUTHOR]

Background: A large proportion of European children, adults and older adults do not engage in sufficient physical activity (PA). Understanding individual and contextual factors associated with PA behaviours is essential for the identification and implementation of effective preventative environments, policies, and programmes that can promote an active lifestyle across life course and can potentially improve health. The current paper intends to provide 1) a multi-disciplinary, Pan-European and life course view of key determinants of PA behaviours and 2) a proposal of how these factors may cluster. Methods: After gathering a list of 183 potential PA behaviours-associated factors and a consensus meeting to unify/ consolidate terminology, a concept mapping software was used to collate European experts' views of 106 identified factors for youth (<19 years), adults (19-64 years), and older adults (≥65 years). The analysis evaluated common trends in the clustering of factors and the ratings of the distinct factors' expected modifiability and population-level impact on PA behaviours across the life course. Priority for research was also assessed for each cluster. Results: The concept mapping resulted in six distinct clusters, broadly merged in two themes: 1) the 'Person', which included clusters 'Intra-Personal Context and Wellbeing' and 'Family and Social Economic Status' (42% of all factors) and 2) the 'Society', which included the remaining four clusters 'Policy and Provision', 'Cultural Context and Media', 'Social Support and Modelling', and 'Supportive Environment' (58% of all factors). Overall, 25 factors were rated as the most impactful on PA behaviours across the life course and being the most modifiable. They were mostly situated in the 'Intra-Personal Context and Wellbeing' cluster. Furthermore, 16 of them were rated as top priority for research. Conclusions: The current framework provides a preliminary overview of factors which may account for PA behaviour across the life course and are most relevant to the European community. These insights could potentially be a foundation for future Pan-European research on how these factors might interact with each other, and assist policy makers to identify appropriate interventions to maximize PA behaviours and thus the health of European citizens. [ABSTRACT FROM AUTHOR]

Background: The Trifecta aortic bioprosthesis (St. Jude Medical, Inc., St. Paul, MN, USA) is a stented pericardial heart valve with excellent preliminary results. Aim of the study was to evaluate its early clinical and hemodynamic performances in a multicenter regional registry.Methods: Between January 2011 and June 2012, 178 consecutive patients undergoing aortic valve replacement with the Trifecta bioprosthesis were prospectively enrolled at 9 Italian centers. Clinical and echocardiographic data were collectedat discharge, 6-months and at 1-year postoperatively.Results: The average age was 75.4 ± 7.7 years,and 95 (53 %) were men. Indication for valve replacement included stenosis in 123 patients (69 %), mixed lesions in 25 (14 %), and regurgitation in 30 (17 %). Ninety-three (52 %) patients were in NYHA functional class III/ IV. Hospital mortality accounted for 5 (2.8 %) patients. No valve-related perioperative complications were encountered. Median follow-up was 20.5 months (range: 1-34). Early (≤6 months) complications included one thromboembolic event, one major bleeding, and 3 endocarditis (2 explants). Two late (>6 months) thromboembolic events and two endocarditis (1 explant) were registered. No valve thrombosis or structural deterioration were observed after discharge. At 30-months, freedom from all-cause mortality was 87 %, freedom from valve-related mortality 99.4 %, freedom from endocarditis 97.5 %, and freedom from valve explants 98 %. At 1-year, mean gradients ranged from 8 to 16 mmHg, and effective orifice area indexes from 1.0 to 1.2 cm(2)/m(2) for valve sizes from 19 to 27 mm, respectively. No patients had severe prosthesis-patient mismatch.Conclusions: Trifecta bioprosthesis provided favourable clinical and hemodynamic results over time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Several studies have clearly shown that physical exercise can reduce the progression of motor symptoms in Parkinson's Disease (PD). However, little is known about the effects of a Nordic Walking (NW) program in PD patients. OBJECTIVE: To determine the effects of a NW program on motor and non-motor symptoms, functional performances and body composition in PD patients. METHODS: Twenty PD patients (16M, 4F, 67.3 ± 7.8 years) were enrolled and randomly assigned to NW group (NWg, n = 10) and Control group (Cg, n= 10). The training consisted in 2 sessions per week for 12 weeks. Training effects were assessed by functional and instrumental tests and motor and non-motor symptoms were assessed by UPDRS-III, Hoehn and Yahr scale, PD Fatigue Scale, Beck Depression Inventory-II, Starkstein Apathy Scale, and Non-Motor Symptoms Scale. RESULTS: Significant changes in resting HR, in walked distance (p<0.05), and in lower limbs muscles strength (p<0.005) were observed in NWg. Both balance abilities and safety with mobility were increased (p < 0.005). Significant variations in some circumferences and body composition were registered. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III, HY scale, PFS-16, BDI-II, SAS, NMSS. CONCLUSIONS: A tailored exercise program including NW proved to be an effective way to improve daily activities and both motor and non-motor symptoms in PD patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Mitral valve surgery for organic mitral regurgitation (MR) in the elderly has been debated. In the elderly, quality of life is a better indicator of surgical success than survival. We assessed quality of life of elderly patients submitted to surgery for MR using the Minnesota Living with Heart Failure (MLHF) questionnaire. Methods: Between August 2003 and August 2006, 225 consecutive patients >70 years old underwent surgical treatment of organic MR. Mean age was 77±3.3 years (range 71–87 years). Mean EF was 50±11%. Degenerative disease was the most prevalent (77%) etiology. CABG was associated in 25% of patients. Mean Charlson score was 4.3±1.5 and 101 patients (45%) were NYHA class III and IV. Hospital survivors were followed up and quality of life by MLHF score was assessed. Results: Mitral repair and replacement were equally distributed in this population. Hospital mortality was 2.7%. Late survival was 91±1.9% at 3 years. MLHF was obtained from 204 patients at mean 2±1 years of follow-up. MLHF score was 38±18; there were 135 (66%) patients with MLHF >30. MLHF tended to increase with age at follow-up (p =0.007). Multivariable predictors of MLHF were preoperative atrial fibrillation (p =0.019), diabetes (p =0.03), higher creatinine level (p =0.0009), higher EuroSCORE (p =0.02), residual mitral regurgitation grade at follow-up echocardiography (p <0.0001) and systolic pulmonary artery pressure at follow-up (p =0.04). Type of surgical treatment (repair vs replacement and choice of prosthesis) did not predict MLHF at follow-up, although those who had recurrent MR after repair had the highest scores compared to patients who had repair and durable result and those treated by replacement (MLHF was 51±21, vs 34±16, vs 39±18, respectively, p =0.0013). Conclusions: Quality of life following mitral valve surgery is suboptimal in more than half of elderly patients. MLHF score at follow-up is mostly related to preoperative conditions. Type of surgery does not influence MLHF score, however, quality of life is worse in patients with recurrent/residual MR following repair. [Copyright &y& Elsevier]

Annular dilation is a common feature of chronic degenerative mitral regurgitation caused by leaflet prolapse. Accordingly, patients undergoing surgical repair usually undergo concomitant reductive annuloplasty to restore a normal annular-to-leaflet relation. With the evolution of transcatheter valve repair technologies, patient selection criteria for those who do not require annuloplasty are needed. A series of patients undergoing mitral repair was analyzed, and the role of annular-to-leaflet mismatch in identifying patients requiring reductive annuloplasty was explored. Preoperative data for 82 patients undergoing mitral repair with annuloplasty for degenerative mitral regurgitation were prospectively collected, including annular intercommissural (IC) and septolateral (SL) dimensions and heights of anterior (ALH) and posterior leaflets. An SL/ALH ratio >1.4 was used to define annular-to-leaflet mismatch. After mitral repair, the ratio between preoperative IC distance and the size of the implanted annular prosthesis (Seguin ring [SR], IC/SR <1.2) was used to identify patients for whom annuloplasty was nonreductive. All patients underwent successful mitral repair. Mean preoperative IC was 46 ± 6 mm, SL was 42 ± 5 mm, and ALH was 31 ± 5 mm. Mean SR was 34 ± 3 mm, with a mean IC/SR ratio of 1.34 ± 0.14. Sixteen patients (19%) had an IC/SR ratio <1.2. IC/SR ratio <1.2 was predicted by a SL/ALH ratio ≤1.4 (p = 0.009). In conclusion, annular dilation is negligible in <20% of surgical candidates. In this subgroup, an isolated leaflet repair may be indicated. SL/ALH ratio is a good indicator of annular-to-leaflet mismatch and could be used as an adjunct to other methods of annular function assessment to select patients for ringless mitral repair. [Copyright &y& Elsevier]

Background. Although outdoor water sport activities are gaining increasing attention for their therapeutic potential in the social and care management of populations with chronic dis- eases, these practices are currently underutilised. Moreover, the available body of literature on the topic has not been critically and systematically assessed yet. Aims. (1) To appraise the health effects of outdoor water sport activities for chronic disease populations; (2) to identify potential gaps and avenues of development for this emerging field. Methods. A systematic review was carried out searching PubMed (including MEDLINE), Physiotherapy Evidence Database (PEDro) and Scopus from inception to December 2021. Only outdoor water sport interventions specifically designed for therapeutic purposes for individuals with chronic disease were included. The quality score of each study was calculated with the Tool for the assEssment of Study qualiTy and reporting in Exercise (TESTEX) tool. Results. Fifteen studies (five RCTs, seven non-RCTs and three CTs with healthy subjects as controls) met the inclusion criteria and were assessed. Among the studies selected, two focused on canoa kayak, one on stand-up paddle, two on surfing, two on sailing activity, and eight on dragon boat padding. The median TESTEX score for study quality and reporting was 6/15, i.e ., “very low” (range 5–8). Meta-analyses were not performed because none of the five RCTs retrieved shared data on at least one similar outcome. Based on the qualitative analysis, the few individual studies that could be included reported generally positive results, ranging from improvements in antioxidant action and cardiovascular function for dragon boating, to beneficial effects on balance, postural control, and flexibility for on-water paddle board activities. Overall, outdoor water sport interventions were associated to higher rates of adherence than conventional trainings. Conclusions. Very low to low quality evidence from a limited set of pilot studies seems to suggest beneficial effects of outdoor water sports for chronic disease populations. However, such preliminary findings need to be replicated through large, high-quality RCTs to be conducted in target populations. Avenues of development and translational perspectives for this specific research field are proposed and discussed. [ABSTRACT FROM AUTHOR]

Background. Low back pain (LBP) is a widespread musculoskeletal complaint reported by athletes, often from an early age. The purpose of this retrospective survey was to analyse the prevalence of LBP among Italian adolescent soccer players, and to identify potential risk factors. Methods. Participants were requested to answer an online survey based on the standardized Nordic questionnaires for musculoskeletal symptoms. Results. Data were obtained from 204 male soccer players aged 14-17 years competing at the national and regional level. More than half of the players had experienced LBP in their lives. One-way ANOVA revealed that the players with LBP were taller, heavier and with a higher BMI (all p values<0.00001). When considering the playing position, ANOVA revealed that 14-15 years-old strikers displayed higher LBP scores than all other roles (all p values< 0.05). Accordingly, strikers were exposed to a higher risk of LBP than midfielders (RR=1.48; 95%CI:1.10-2.01; p=0.01) and goalkeepers (RR=1.48; 95%CI:1.02-2.971; p=0.04), but not defenders (RR=1.23; 95%CI:0.93-1.63; p=0.15). Within the 14-15 age-class, strikers were, again, those most exposed to LBP risk (all p values<0.05). Conclusions. Anthropometric and soccer-related features should be monitored to ensure early identification of potential risk factors for LBP. This information should be considered along with the specific playing position as strikers emerged as the roles most exposed to LBP. [ABSTRACT FROM AUTHOR]

Sedentary behavior (SB) in post-menopause has been associated with an elevated cardiovascular risk, in particular venous thrombosis, regardless of physical activity (PA) levels. Interrupting SB with intermittent light-intensity or moderate to vigorous-intensity physical activity (LPA and MVPA, respectively) can avoid hypercoagulation associated with prolonged sitting. However, no studies examined this effect in free-living context using objectively measured SB and PA. This study was aimed to investigate the association between objectively measured SB patterns (i.e. duration and number of sedentary bouts) and hemostatic parameters. Fifty-two non-smoker post-menopausal women (age: 59.7 ± 6.2 yo; BMI: 27.3 ± 4.4) worn a multisensory device (Sensewear Armband, BodyMedia, Inc., Pittsburgh, PA) for at least three days to measure SB and PA. Blood samples were collected to measure hemostatic parameters. Data were log-transformed (log-) when non-normally distributed. Correlation was analyzed by Pearson's correlation coefficient, controlling for BMI, log-MVPA or total sedentary time (ST), depending on the need. Difference between women with daily SB bouts lasting at least 1 hr and women with shorter bouts was analyzed by Mann-Whitney U-test. Women were really active (102.5 ± 82.6 min/d MVPA) and with a large amount of SB (589.2 ± 132.5 min/d SB). Plasma fibrinogen was directly correlated with both ST and lying time, independently from BMI and log-MVPA (r = .338, P = .016; r = .374, P = .007) and inversely correlated with log-MVPA (r = -.376, P = .006). No correlation was found for sleep time. The number of bouts of SB lower than 5 or 10 min were not associated with fibrinogen, while the number of bouts of SB between 11 and 15, 11 and 20, and 21 and 30 min were directly correlated with plasma fibrinogen, regardless of BMI, ST, and log-MVPA (r = .276, P = .05; r = .315, P = .028; r = .275, P = .05, respectively). Furthermore, women with daily uninterrupted SB longer than 1 hr had higher plasma fibrinogen than other participants (323.9 ± 41.4 mg/dl; 287.7 ± 48.8 mg/dl, respectively; Z = -2.53, P = .011). In conclusion, uninterrupted SB is associated with adverse fibrinogen levels, regardless of ST and PA, while shorter bouts of SB are not directly associated with it. These results suggest that activity breaks mitigate the procoagulant effects of uninterrupted sitting, in post-menopausal women. [ABSTRACT FROM AUTHOR]

Background: A large proportion of European children, adults and older adults do not engage in sufficient physical activity (PA). Understanding individual and contextual factors associated with PA behaviours is essential for the identification and implementation of effective preventative environments, policies, and programmes that can promote an active lifestyle across life course and can potentially improve health. The current paper intends to provide 1) a multi-disciplinary, Pan-European and life course view of key determinants of PA behaviours and 2) a proposal of how these factors may cluster.Methods: After gathering a list of 183 potential PA behaviours-associated factors and a consensus meeting to unify/consolidate terminology, a concept mapping software was used to collate European experts' views of 106 identified factors for youth (<19 years), adults (19-64 years), and older adults (≥65 years). The analysis evaluated common trends in the clustering of factors and the ratings of the distinct factors' expected modifiability and population-level impact on PA behaviours across the life course. Priority for research was also assessed for each cluster.Results: The concept mapping resulted in six distinct clusters, broadly merged in two themes: 1) the 'Person', which included clusters 'Intra-Personal Context and Wellbeing' and 'Family and Social Economic Status' (42 % of all factors) and 2) the 'Society', which included the remaining four clusters 'Policy and Provision', 'Cultural Context and Media', 'Social Support and Modelling', and 'Supportive Environment' (58 % of all factors). Overall, 25 factors were rated as the most impactful on PA behaviours across the life course and being the most modifiable. They were mostly situated in the 'Intra-Personal Context and Wellbeing' cluster. Furthermore, 16 of them were rated as top priority for research.Conclusions: The current framework provides a preliminary overview of factors which may account for PA behaviour across the life course and are most relevant to the European community. These insights could potentially be a foundation for future Pan-European research on how these factors might interact with each other, and assist policy makers to identify appropriate interventions to maximize PA behaviours and thus the health of European citizens. [ABSTRACT FROM AUTHOR]