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Background: Low-volume high-intensity interval training (HIIT) may be a time-efficient strategy that leads to similar or superior improvements in cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) risk factors when compared with moderate-intensity continuous training (MICT). Our study investigated the effect of low-volume HIIT or MICT versus sham placebo-control (PLA) on central arterial stiffness, hemodynamic responses, and CVD risk factors in adults with obesity and type 2 diabetes (T2D)., Methods: Eligible participants were previously inactive adults with obesity and T2D. Individuals were randomly allocated to: i) HIIT (1 × 4 min cycling at 90% peak oxygen consumption [V̇O 2peak ]); ii) MICT (45 min of cycling at 60% VO 2peak ); or PLA. Training groups exercised thrice weekly for 12 weeks. Central arterial stiffness, hemodynamics and CVD risk factors were assessed at baseline and post-intervention. Analysis of covariance (ANCOVA) was used to examine changes following HIIT, MICT and PLA., Results: Thirty-five participants (age: 55.1 ± 1.4 years, BMI: 36.1 ± 0.8 kg/m 2 ) completed the study. A significant intervention effect was found for changes in pulse wave velocity (PWV) (p = .03), which reduced with HIIT (-0.3 ± 0.9 m/s) and MICT (-0.1 ± 1.1 m/s) but increased with PLA (0.8 ± 1.6 m/s). There was a significant intervention effect for changes in V̇O 2peak (p < .01), glycosylated hemoglobin (p = .03), systolic blood pressure (p < .01), and waist circumference (p = .03), which all improved following MICT or HIIT but not PLA; there was no difference between MICT and HIIT., Conclusions: Twelve minutes of low-volume HIIT per week leads to improvements in central arterial stiffness and cardiovascular health in inactive individuals with obesity and T2D., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Localized rectal carcinoma is invasive, with surgical resection the standard treatment. The aim of this study was to determine the feasibility of a supervised presurgical exercise intervention in patients with rectal cancer prior to rectal resection., Patients and Methods: Twelve patients volunteered to undertake twice-weekly aerobic and resistance exercise for ∼16 weeks prior to surgery. At baseline, presurgery, and ∼8 weeks postsurgery, muscle strength and physical performance, body composition, quality of life, and fatigue were assessed., Results: Ten patients completed training, with 80% completing more than one-half of the exercise sessions. Muscle strength improved 9% to 29% at presurgery, although this was not statistically significant, and declined postsurgery (P < .05). Importantly, postsurgery strength levels were comparable with pretraining levels. Lean mass was preserved at presurgery despite neoadjuvant chemoradiation treatment, whereas postsurgery lean mass decreased (P < .05) compared with baseline (-3.2 ± 5.4 kg) and presurgery (-3.7 ± 5.4 kg). There were no substantial changes in quality of life or fatigue., Conclusion: Presurgical exercise is feasible, leading to modest improvements in some outcomes despite chemoradiation treatment. The detrimental effects of surgery were evident, especially in relation to lean mass. As such, exercise may facilitate recovery by enhancing presurgery physical reserve capacity, thereby providing a buffer to declines following surgery., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Because of the low historical prevalence of measurable disease in metastatic castration-resistant prostate cancer (mCRPC), phase II trials have used prostate-specific antigen (PSA) and bone scan changes as primary end points. Frequent whole-body imaging and improved computed tomography technology currently identify measurable disease more frequently, warranting consideration of objective response as a major end point., Patients and Methods: Data from reported phase III trials of mCRPC were analyzed. The proportion of patients with measurable disease, setting (pre-docetaxel [D], D-based, post-D), year of starting accrual, PSA, and the requirement for symptoms were collected. The χ 2 test was used to evaluate the association of variables with measurable disease rate., Results: Twenty phase III trials totaling 19,276 men with mCRPC were evaluable. Three trials (n = 1289) started accruing before 2000 and 17 trials (n = 17,987) accrued after 2000. The proportion of measurable disease rate for all trials was 47.5%. The measurable disease rate was significantly higher (P < .001) in trials that accrued after 2000 versus before 2000 (48.7% vs. 31.1%; P < .001), D-based (51.8%) or post-D patients (48.9%) compared with pre-D patients (38.6%) and in trials allowing symptomatic versus asymptomatic/minimally symptomatic patients (50.1% vs. 40.0%)., Conclusion: The proportion of men with measurable disease was significantly higher in phase III trials of mCRPC that accrued after 2000, in D-based or post-D patients and in trials that allowed symptomatic patients. Because of the association of objective measurable changes with survival, Response Evaluation Criteria in Solid Tumors changes might warrant consideration as a major end point in phase II trials to obtain a firm signal of efficacy before launching phase III trials., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background & Aims: Aerobic exercise reduces liver fat and visceral adipose tissue (VAT). However, there is limited data from randomized trials to inform exercise programming recommendations. This study examined the efficacy of commonly prescribed exercise doses for reducing liver fat and VAT using a randomized placebo-controlled design., Methods: Inactive and overweight/obese adults received 8 weeks of either; i) low to moderate intensity, high volume aerobic exercise (LO:HI, 50% VO 2peak, 60 min, 4d/week); ii) high intensity, low volume aerobic exercise (HI:LO, 70% VO 2peak, 45 min, 3d/week); iii) low to moderate intensity, low volume aerobic exercise (LO:LO, 50% VO 2peak, 45 min, 3d/week); or iv) placebo (PLA). Liver fat (spectroscopy) and VAT (magnetic resonance imaging) were measured before and after intervention., Results: Forty-seven of the 48 (n = 12 in each group) participants completed the trial. There were no serious adverse events. There was a significant change in group × time interaction in liver fat, which reduced in HI:LO by 2.38 ± 0.73%, in LO:HI by 2.62 ± 1.00%, and in LO:LO by 0.84 ± 0.47% but not in PLA (increase of 1.10 ± 0.62%) (p = 0.04). There was a significant reduction in VAT in HI:LO (-258.38 ± 87.78 cm(3)), in LO:HI (-386.80 ± 119.5 cm(3)), and in LO:LO (-212.96 ± 105.54 cm(3)), but not in PLA (92.64 ± 83.46 cm(3)) (p = 0.03). There were no significant differences between the dose or intensity of the exercise regimen and reductions in liver fat or VAT (p > 0.05)., Conclusion: The study found no difference in efficacy of liver fat reduction by either aerobic exercise dose or intensity. All of the aerobic exercise regimens employed reduced liver fat and VAT by a small amount without clinically significant weight loss., (Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background: Mild cognitive impairment (MCI) increases dementia risk with no pharmacologic treatment available., Methods: The Study of Mental and Resistance Training was a randomized, double-blind, double-sham controlled trial of adults with MCI. Participants were randomized to 2 supervised interventions: active or sham physical training (high intensity progressive resistance training vs seated calisthenics) plus active or sham cognitive training (computerized, multidomain cognitive training vs watching videos/quizzes), 2-3 days/week for 6 months with 18-month follow-up. Primary outcomes were global cognitive function (Alzheimer's Disease Assessment Scale-cognitive subscale; ADAS-Cog) and functional independence (Bayer Activities of Daily Living). Secondary outcomes included executive function, memory, and speed/attention tests, and cognitive domain scores., Results: One hundred adults with MCI [70.1 (6.7) years; 68% women] were enrolled and analyzed. Resistance training significantly improved the primary outcome ADAS-Cog; [relative effect size (95% confidence interval) -0.33 (-0.73, 0.06); P < .05] at 6 months and executive function (Wechsler Adult Intelligence Scale Matrices; P = .016) across 18 months. Normal ADAS-Cog scores occurred in 48% (24/49) after resistance training vs 27% (14/51) without resistance training [P < .03; odds ratio (95% confidence interval) 3.50 (1.18, 10.48)]. Cognitive training only attenuated decline in Memory Domain at 6 months (P < .02). Resistance training 18-month benefit was 74% higher (P = .02) for Executive Domain compared with combined training [z-score change = 0.42 (0.22, 0.63) resistance training vs 0.11 (-0.60, 0.28) combined] and 48% higher (P < .04) for Global Domain [z-score change = .0.45 (0.29, 0.61) resistance training vs 0.23 (0.10, 0.36) combined]., Conclusions: Resistance training significantly improved global cognitive function, with maintenance of executive and global benefits over 18 months., (Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Lower limb dynamic alignment represents the limb position during functional loading conditions and obtains valuable information throughout the gait cycle rather than a single instant in time. This study aims to determine whether dynamic alignment is altered in medial knee osteoarthritis (OA) and how dynamic alignment is related to knee adduction moment (KAM). Community-dwelling women (n=17) with medial OA in at least one knee, according to the American College of Rheumatology criteria and 17 body mass index-matched women without OA were recruited. A three-dimensional motion analysis system was used to collect the gait data at self-selected habitual and maximal speeds. Clinical evaluation of lower extremities, physical function, pain, habitual level of physical activity, quality of life and physical self-efficacy were assessed. Shank adduction angle and shank mean angular velocity were significantly greater in the OA group compared to the controls from heel strike to 30% stance. KAM was not different between the groups (p=0.542). Dynamic alignment variables were the best predictors of KAM. Health-related quality of life, habitual level of physical activity, lower extremity muscle strength and balance performance were impaired in the OA group compared to the controls. The importance of variables that contribute to dynamic alignment and the contribution of limb alignment to KAM were highlighted in this study. Detection of postural changes such as altered dynamic alignment in early stages of OA will lead to the institution of joint-protective measures including changes in footwear, orthotics, gait re-training, use of assistive devices to reduce weight-bearing loads, strengthening and balance enhancing exercises, better analgesia, or cartilage-preserving pharmacotherapy.

We report the case of a 25-year-old African-American man presenting to the Henry Ford Hospital emergency department with acute dyspnea secondary to a pneumothorax resulting from a migratory acupuncture needle. The patient received acupuncture treatment approximately 5 years prior to this presentation for treatment of posttraumatic chronic right shoulder pain. Chest radiography revealed retained needles in his right shoulder girdle and a needle overlying the thoracic cage with an attendant pneumothorax. Catheter aspiration for simple pneumothorax provided immediate symptomatic relief. Video-assisted thoracoscopy was then used to remove the migratory acupuncture needle from the chest wall. The patient recovered without complication and was discharged to home.

To determine whether repeated nerve fiber degeneration and regeneration can induce reduplication of endoneurial microvessel basement membranes (BMs), typical of such conditions as diabetic polyneuropathy, electronmicrographs of endoneurial microvessels of rat peroneal and tibial nerves were studied in repeatedly crushed (10 x) sciatic nerves and compared to microvessels of sham-operated uncrushed nerves. On average, crushed nerves had 2.6, SE +/- 0.1 BMs, whereas control nerves had 2.7, SE +/- 0.1 (P > 0.05). Microvessel cellular components were significantly increased in both number and size in the crushed nerves. These nerves also demonstrated a trend to increased vessel numbers and density. These results are not in keeping with the hypothesis that BM reduplication of endoneurial microvessels is simply due to repeated fiber degeneration and regeneration.