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Objective the main objective was to assess repeatability and learning effect of the six-minute walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective we aimed to identify determinants of improvement in the second test. Materials and Methods secondary analysis from a large prospective study on the implementation of a multimodal prehabilitation program in a real-life scenario. Eligible patients were assessed at baseline before starting the prehabilitation program. The 6MWT was conducted according to the American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines with two tests being performed under identical conditions separated by 30 minutes. The distance covered (in meters) and the physiological responses (heart rate, oxygen saturation, fatigue and dyspnea) to each test were recorded and compared. Results 170 patients (60.9%) were analyzed. Repeatability of the distance covered with the 6MWT was excellent (ICC = 0.98; 95% CI: 0.92 – 0.99), but a mean increase of +19.5 meters (95% CI: 15.6 - 23.5m; p=

The aim of this study was to compare the immediate effects of cold-water immersion (CWI) and hot-water immersion (HWI) versus passive resting after a fatigue-induced bout of exercise on the muscle contractile properties of the Vastus Medialis (VM). We conducted a randomised cross-over study involving 28 healthy active men where muscle contractile properties of the VM wer recorded using Tensiomyography (TMG) before and after CWI, HWI or passive resting and up to one-hour post-application. The main outcomes obtained were muscle displacement and velocity of deformation according to limb size (Dmr and Vdr). Our results showed a significant effect of time (F(3.9,405) =32.439; p

Spanish Ministry of Education Culture and Sport, Grant/Award Number: FPU17/00939; Universidad de Granada/CBUA, Background: Aquatic therapeutic exercise can be equally effective or even superior to land-based exercise in improving several clinical variables. However, there is still a lack of knowledge on the effects compared to land-based interventions particularly in breast cancer (BC) patients. Objective: The objective of this study is to examine the effects of aquatic therapeutic exercise on pain, shoulder mobility, lymphedema, cardiorespiratory fitness, muscle strength, body composition, pulmonary function, cancer-related fatigue (CRF) and health-related quality of life (HRQoL) and which parameters are effective compared to similar land-based interventions. Methods: The databases used were PubMed, Scopus, Web of Science, Cochrane Library and CINAHL, retrieving 145 articles. Results: Eleven studies were included. Aquatic therapeutic exercise is feasible, safe, well tolerated and achieved high percentages of adherence. As for the assessed outcomes, moderate to large improvements were found compared to usual care or to land-based physical exercise interventions in pain, shoulder range of motion, pulmonary function, HRQoL, cardiorespiratory fitness and muscle strength. Inconclusive results were found for lymphedema, body composition and CRF. Conclusions: Aquatic therapeutic exercise interventions using a combination of endurance, strength, mobility, stretching and breathing exercises resulted in improvements in common side effects of BC and its treatments. More studies on CRF, body composition and lymphedema need to be done to further evaluate the impact of the intervention on these outcomes., Spanish Ministry of Education Culture and Sport FPU17/00939, Universidad de Granada/CBUA

Estudio de los polimorfismos del gen de la timidilato sintasa y los genes reparadores del ADN ERCC1 y XRCC1 y su relación con la rdespuesta al tratamiento neoadyvante con qumiorradioterapia basada en capecitabin, en pacientes afecto de carcinoma colorrectal de localmente avanzado. Estudi dels polimorfismes del gen de la timidilato sintasa i els gens reparadors del ADN ERCC1 i XRCC1 i la seva relació amb la reposta al tractament neoadjuvant amb quimiorradioterapia basada en capacitabina, en pacients afectes de carcinoma colorrectal localmente avançat.

Colorectal cancer (CRC) brain metastases (BM) are an uncommon and late event. We aim to investigate the impact of clinical factors, treatment modalities and RAS/BRAF status on the outcomes of CRC patients with BM. We retrospectively analysed CRC patients who developed BM in our centre between January 1997 and June 2017. Clinical factors, treatment modalities, RAS/BRAF status and survival were evaluated. Twenty-eight patients were recorded; 82% had left-sided (LS) CRC and 71% had lung metastases. Median time to BM diagnosis was 36 months (m) and 93% of patients received local treatment of BM (43% whole brain radiotherapy, 50% surgery). Right-sided (RS) CRC showed shorter time to BM, not previously described (9.3 vs 46.6 m for RS and LS CRC, respectively; HR = 4.7, p = 0.006). Median overall survival (mOS) from BM treatment was 9.5 m, better in patients who underwent surgery than those treated with radiotherapy alone (12.1 vs 4.6 m, respectively; HR = 0.3, p = 0.019) and in those without progressive metastatic extracranial disease (7.2 vs 20.9 m, for progressive and non-progressive, respectively; HR = 0.3, p = 0.056). Patients with two or more metastatic extracranial locations showed worse prognosis (5.9 vs 16.3 m, for > 2 vs 0–1, respectively; HR = 3.7, p = 0.015). RAS/BRAF status did not showed prognostic value. Time to BM diagnosis is shorter in RS CRC. The presence of two or more metastatic extracranial locations and progressive metastatic extracranial disease at the time of BM diagnosis could be bad prognosis factors for CRC BM patients.

Objectives: To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery. Design: Randomized, single-blind controlled trial. Setting: Teaching hospital. Subjects: Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery. Intervention: Participants were randomized to either a prehabilitation group or a control group. Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week. Main measures: The primary outcome of the study was exercise capacity. Secondary outcomes were muscle strength (Senior Fitness Test), health-related quality of life (Short-Form 36) and the postoperative outcomes. Patients were evaluated at baseline (before randomization), presurgery (only the prehabilitation group), after surgery and three months post-operatively. Results: A total of 40 patients were randomized and 22 finished the study (10 in the prehabilitation group and 12 in the control group). Three patients were lost to follow-up at three months. After the training, there was a statistically significant improvement in exercise tolerance (+397 seconds, p = 0.0001), the physical summary component of the SF-36 (+4.4 points, p = 0.008) and muscle strength ( p Conclusions: A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients’ preoperative condition and may prevent functional decline after surgery. Clinical Registration Number: NCT01963923 (Registration date 10/10/2013)

Background/aim Prenatal exposure to organochlorine compounds (OCs) can increase the risk of adverse respiratory symptoms in children and adolescents, but evidence is mainly based on reported symptoms and it is still unknown whether these compounds can impact on lung function. We assessed the longitudinal association between prenatal exposure to OCs and lung function until early adulthood. Methods We included 2750 participants belonging to the INMA (Infancia y Medio Ambiente) prospective birth cohort in Spain in Menorca, Valencia, Gipuzkoa, and Sabadell regions. Prenatal concentrations of OCs (hexachlorobenzene [HCB], dichlorodiphenyltrichloroethane [DDT], dichlorodiphenyldichloroethylene [DDE], and four polychlorinated biphenyls [PCB-118, PCB-138, PCB-153, and PCB-180]) from each participant were measured in maternal or cord serum. Lung function was measured by spirometry at 4, 7, 9, 11, 14, and 18 years of age. Multivariate linear regression models were used to assess the association between prenatal OCs concentrations and lung function. Results High percentage of samples presented quantifiable levels of all the analysed OCs. DDE, HCB, and PCB-153 were the compounds with higher median concentrations (e.g. median for DDE=1.03 ng/mL; Inter quartile range=1.37 ng/mL). Preliminary results in the Menorca cohort (n=327) revealed that prenatal exposure to the second tertile of PCB-153 concentrations was associated with reduced forced vital capacity (FVC) and reduced forced expiratory volume in 1 s (FEV1) when compared to the lowest tertile at 11 and 14 years (e.g. β for FVC at 14 years=-0.17 L; 95% CI: −0.31 to −0.03). Exposure to the second tertile of DDE and PCB-118 was associated with reduced FVC at 11 years, compared to the lowest tertile. No other associations were found. Final results including all cohorts will be presented. Conclusion Preliminary results showed that prenatal exposure to OCs was associated with reduced lung function until adolescence. Such exposure might alter the structural development of the lung and predispose for chronic respiratory diseases later in life.

Background Hepatic resection of liver metastases is considered the optimal potentially curative treatment for colorectal liver metastases. Numerous clinical and pathological factors have been proved to be prognostic. The Genetic And Morphological Evaluation (GAME) has been proposed as a preoperative prognostic tool to select patients candidates for liver resection. This study aimed to validate the utility of GAME score risk groups in patients with colorectal liver metastases that underwent hepatic resection. Methods Clinical and pathological data were collected from 142 metastatic colorectal cancer patients undergoing liver resection (48% after neoadjuvant chemotherapy) between August 1999 and February 2018 at Sant Pau Hospital. The GAME score was calculated allocating points for KRAS mutation, CEA levels, lymph node metastasis, Tumour Burden score (TBS) and extrahepatic disease. We analysed the progression free survival (PFS) and overall survival (OS) according to the GAME score risk groups. Additionally, we considered other KRAS, NRAS and BRAF mutations not included in the original GAME score. Histopathological changes in malignant tissue and liver parenchyma were documented to identify potential prognostic factors for tumor recurrence. Results The high-risk group (GAME score ≥ 4 points) had a median PFS of 15.8 months compared with 24.2 months for the low-risk group (GAME score 0–1 point; p = 0.019). The high-risk group had a medium OS of 38.6 months compared with 68.8 months for the low-risk group (p = 0.05). When all RAS and BRAF status was considered regardless of the GAME score a median OS of 66.2 months was observed in wild type tumours compared to 44.5 months for mutated tumours (p = 0.005). Histological examination showed that a mixed and infiltrative growth pattern and the absence of a fibrotic pseudocapsule or liver cell rosettes were associated with a worse outcome. Conclusions The GAME score was validated as a useful preoperative prognostic tool in our cohort of patients. However, in our series, molecular profile was a prognostic factor regardless of the GAME score. Some pathologic characteristics may help on further clinical decisions after liver resection. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Introduction: Preoperative exercise training can improve the baseline status of patients undergoing open thoracic surgery and therefore improve surgical tolerability and enhance postoperative recovery. The aim of this study was to assess the feasibility and preliminary efficacy of a preoperative exercise-based programme (PEP) in patients undergoing Video-assisted thoracic surgery (VATS) for lung cancer. Materials and Methods: In a randomized, single blinded controlled trial, 20 patients were allocated to receive a PEP consisted of 3 - 5 sessions per week of interval endurance training, strength training with elastic bands and breathing exercises. Exercise capacity (endurance time), muscle strength (Senior Fitness Test) and health-related quality of life (SF-36) were assessed at the beginning and at the end of the training. Results: 10 patients completed the intervention attending a median of 16 sessions. Mean therapeutic delay was 54 days and no adverse events were recorded. There were statistically significant improvements in endurance time measured at 80% of the maximal workload (mean difference +396.6±197.9 seconds, p Conclusions: preoperative exercise training in patients with lung malignancies awaiting VATS is safe and can be achieved without any delay in the surgical management and results effective to improve exercise capacity, muscle strength and physical functioning, which could potentially enhance postoperative recovery.

The aim of this cross-sectional study was to compare dynamic lung volumes in chronic stroke survivors (SS) with a control group (CG) of healthy people matched by age and sex. Forced spirometries were performed, in line with the international statements. The reference values were calculated with the predictive equations proposed by Roca et al,1986. T test was used to determine differences in dynamic lung volumes between SS and CG.A cluster analysis was practiced to classify 2 different groups within the SS regarding to their dynamic lung volumes. The average age in SS (n=33) was 56.9±15.7 years. There were no significant differences between groups regarding age, weight and height. The average months since the stroke was 48.8±68.8. The SS present significantly lower values in dynamic lung volumes compared to the GC (n=33). The cluster analysis showed a trend towards a restrictive ventilatory pattern in SS since 19 subjects showed values of FVC and FEV1 below the mean registered for the whole group of SS. According to these findings we suggest that the assessment of pulmonary function should be considered in chronic SS.

Lung cancer is the leading cause of cancer-related death worldwide. For early stages of the disease, lung resection surgery remains the best treatment with curative intent, but significant morbidity is associated, especially among patients with poor pulmonary function and cardiorespiratory fitness. In those cases, the implementation of a preoperative exercise-based intervention could optimize patient's functional status before surgery and improve postoperative outcomes and enhance recovery. The aim of this systematic review is to provide the current body of knowledge regarding the effectiveness of a preoperative exercise-based intervention on postoperative and functional outcomes in patients with lung cancer submitted to lung resection surgery. A systematic review of the literature using CINAHL, EMBASE, MEDLINE, Pubmed, PEDro and SCOPUS was undertaken in September 2015 yielding a total of 1656 references. Two independent reviewers performed the assessment of the potentially eligible records against the inclusion criteria and finally, 21 articles were included in the review. Articles were included if they examined the effects of an exercise-based intervention on at least one of the selected outcomes: pulmonary function, (functional) exercise capacity, health-related quality of life (HRQoL) and postoperative outcomes (length of stay and postoperative complications). Fourteen studies were further selected for a meta-analysis to quantify the mean effect of the intervention and generate 95% confidence intervals (CIs) using the Cochrane Review Manager 5.0.25. For two of the outcomes included (exercise capacity and HRQoL), studies showed large heterogeneity and thus, a meta-analysis was considered inappropriate. Pulmonary function (forced vital capacity and forced expiratory volume in 1 s) was significantly enhanced after the intervention [standardized mean difference (SMD) = 0.38; 95% CI 0.14, 0.63 and SMD = 0.27, 95% CI 0.11, 0.42, respectively]. In comparison with the patients in the control groups, patients in the experimental groups spent less days in the hospital (mean difference = -4.83, 95% CI -5.9, -3.76) and had a significantly reduced risk for developing postoperative complications (risk ratios = 0.45; 95% CI 0.28, 0.74). In conclusion, preoperative exercise-based training improves pulmonary function before surgery and reduces in-hospital length of stay and postoperative complications after lung resection surgery for lung cancer.