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1.
Radioactive Iodine in Differentiated Thyroid Carcinoma: A Systematic AGREE II Clinical Practice Guideline Appraisal.
Monos, S, Fritz, C, Harris, J, Romeo, D, Ng, JJ, Xu, K, Cooperberg, B, Moreira, A, Rajasekaran, K
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2024;(1):20-33
Abstract
OBJECTIVE Identify and appraise clinical practice guidelines (CPGs) for radioactive iodine (RAI) indications in differentiated thyroid carcinoma (DTC), and the treatment for radioactive iodine refractory (RAI-R) DTC using the Appraisal of Guidelines for Research and Evaluation II tool. DATA SOURCES MEDLINE (Pubmed), Ovid (EMBASE), and Scopus. REVIEW METHODS A systematic literature search was conducted to identify CPGs addressing RAI in DTC. CPGs were appraised by 4 independent reviewers in 6 distinct areas of quality. Scaled domain scores were subsequently calculated for each domain. Intraclass correlation coefficients were calculated for each domain to assess interrater reliability. RESULTS Sixteen guidelines were found addressing RAI indications for DTC. Of these 16, 9 also addressed the treatment of RAI-R DTC. A further 6 unique guidelines were identified that exclusively address RAI-R DTC, bringing the total number of guidelines to 22. The American Thyroid Association (ATA) guidelines for adult thyroid cancer were the highest scoring with a mean score of 83.5%. Two guidelines scored >60% in 5 or more domains, qualifying as "high" quality: ATA and British Thyroid Association. The highest scoring domain was domain 4: clarity of presentation (80.4%) while the lowest scoring domain was domain 5: applicability (38.6%). CONCLUSION Of the 22 guidelines identified, only two were "high quality." CPGs exclusively addressing the treatment of RAI-R DTC were weak with most guidelines scoring in the "low" quality range. This report reveals an unmet need for rigorously developed guidelines addressing indications for RAI in DTC, as well as the treatment for RAI-R DTC.
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Multidimensional Health Impact of Multicomponent Exercise and Sustainable Healthy Diet Interventions in the Elderly (MED-E): Study Protocol.
Sampaio, J, Carvalho, J, Pizarro, A, Pinto, J, Moreira, A, Padrão, P, Guedes de Pinho, P, Moreira, P, Barros, R
Nutrients. 2023;(3)
Abstract
Data concerning the combined effect of diet and exercise interventions on overall health in the elderly are scarce. The MED-E project's primary aim is to assess the effect of the different 3-month sustainable healthy diet (SHD) and multicomponent training (MT) interventions on several health outcomes in the elderly. A quasi-experimental study assigned older adults into four groups: (1) SHD, (2) MT, (3) SHD + MT, or (4) control group (CG). The SHD intervention included a weekly offer of a mixed food supply and individual and group nutritional sessions on the principles of an SHD. The MT groups were submitted to 50-min exercise sessions three times a week. The primary outcomes were blood biomarkers and metabolic profile alterations that were assessed pre- and post-intervention. Additionally, data on dietary intake and nutritional adequacy, physical fitness, body composition and anthropometry, cognitive function, quality of life, and geographical data were assessed at the same time points. The MED-E project's study protocol and future results will add to knowledge about the importance and beneficial contribution of combined SHD and MT interventions on healthy ageing policies.
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Physical exercise, immune response, and susceptibility to infections-current knowledge and growing research areas.
Kurowski, M, Seys, S, Bonini, M, Del Giacco, S, Delgado, L, Diamant, Z, Kowalski, ML, Moreira, A, Rukhadze, M, Couto, M
Allergy. 2022;(9):2653-2664
Abstract
This review presents state-of-the-art knowledge and identifies knowledge gaps for future research in the area of exercise-associated modifications of infection susceptibility. Regular moderate-intensity exercise is believed to have beneficial effects on immune health through lowering inflammation intensity and reducing susceptibility to respiratory infections. However, strenuous exercise, as performed by professional athletes, may promote infection: in about half of athletes presenting respiratory symptoms, no causative pathogen can be identified. Acute bouts of exercise enhance the release of pro-inflammatory mediators, which may induce infection-like respiratory symptoms. Relatively few studies have assessed the influence of regularly repeated exercise on the immune response and systemic inflammation compared to the effects of acute exercise. Additionally, ambient and environmental conditions may modify the systemic inflammatory response and infection susceptibility, particularly in outdoor athletes. Both acute and chronic regular exercise influence humoral and cellular immune response mechanisms, resulting in decreased specific and non-specific response in competitive athletes. The most promising areas of further research in exercise immunology include detailed immunological characterization of infection-prone and infection-resistant athletes, examining the efficacy of nutritional and pharmaceutical interventions as countermeasures to infection symptoms, and determining the influence of various exercise loads on susceptibility to infections with respiratory viruses, including SARS-CoV-2. By establishing a uniform definition of an "elite athlete," it will be possible to make a comparable and straightforward interpretation of data from different studies and settings.
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Session Rating of Perceived Exertion as an Efficient Tool for Individualized Resistance Training Progression.
Gomes, RL, Lixandrão, ME, Ugrinowitsch, C, Moreira, A, Tricoli, V, Roschel, H
Journal of strength and conditioning research. 2022;(4):971-976
Abstract
Gomes, RL, Lixandrão, ME, Ugrinowitsch, C, Moreira, A, Tricoli, V, and Roschel, H. Session rating of perceived exertion as an efficient tool for individualized resistance training progression. J Strength Cond Res 36(4): 971-976, 2022-The present study aimed to investigate the effects of an individualized resistance training (RT) progression model based on the session rating of perceived exertion (RPE) on gains in muscle mass and strength when compared with a conventional predetermined progression method (PP). Twenty previously trained young male subjects were randomly allocated to 1 of the 2 groups: RPE (n = 10) or PP (n = 10). Muscle cross-sectional area (CSA) and maximum dynamic strength were assessed at baseline and after 6 weeks. The RPE-based progression model resulted in a lower number of high-intensity sessions compared with the PP-based model. Despite this, both groups showed significant and similar increases in CSA (p < 0.0001; RPE = 6.55 ± 5.27% and PP = 9.65 ± 3.63%) and strength (p < 0.0001; RPE = 9.68 ± 4.57% and PP = 9.28 ± 4.01%) after the intervention period. No significant between-group difference was observed for total training volume (RPE = 45,366.00 ± 10,190.00 kg and PP = 47,779.00 ± 5,685.00 kg; p = 0.52). Our results showed that an RT progression model based on session-to-session physiological response assessments resulted in fewer high-intensity training sessions while allowing for similar gains in muscle strength and mass. Thus, trainees are encouraged to adopt session RPE as a potential tool to control workload progression throughout a training period and allowing the optimization of training stimulus on an individual basis.
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Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo.
Santos-Valente, E, Buntrock-Döpke, H, Abou Taam, R, Arasi, S, Bakirtas, A, Lozano Blasco, J, Bønnelykke, K, Craiu, M, Cutrera, R, Deschildre, A, et al
ERJ open research. 2021;(3)
Abstract
INTRODUCTION Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. METHODS Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. RESULTS We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. CONCLUSION Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident.
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N-3 fatty acid supplementation in asthma management: A systematic review and meta-analysis.
Wang, YH, Huang, SY, Kuo, HP, Fan, HY, Moreira, A, Papamichael, MM, Chen, YC
Allergy. 2021;(11):3042-3046
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Health effects of exposure to chlorination by-products in swimming pools.
Couto, M, Bernard, A, Delgado, L, Drobnic, F, Kurowski, M, Moreira, A, Rodrigues-Alves, R, Rukhadze, M, Seys, S, Wiszniewska, M, et al
Allergy. 2021;(11):3257-3275
Abstract
Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.
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Acute effect of high-definition and conventional tDCS on exercise performance and psychophysiological responses in endurance athletes: a randomized controlled trial.
da Silva Machado, DG, Bikson, M, Datta, A, Caparelli-Dáquer, E, Unal, G, Baptista, AF, Cyrino, ES, Li, LM, Morya, E, Moreira, A, et al
Scientific reports. 2021;11(1):13911
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Exercise-induced fatigue can be associated with a limited descending command from the central nervous system to the muscle which may affect muscle contraction and its ability to generate force. Transcranial direct current stimulation (tDCS) is the application of weak electrical current to stimulate different areas of the brain to influence exercise performance and perception. High-definition transcranial direct current stimulation (HD-tDCS) is a modification of conventional tDCS to increase the focality, precision, long-lasting effects and greater neuronal excitability change. This single-centre, randomised, crossover, single-blinded, sham-controlled trial compared the effects of HD-tDCS and conventional tDCS on exercise performance and psychophysiological responses in healthy young male endurance athletes. The study found no effect of HD-tDCS or conventional tDCS on exercise performance and psychophysiological responses to exhaustive exercise. Further robust studies are required to evaluate the effects of both forms of tDCS in athletes compared to non-athletes and its effects when tDCS is applied to other areas of the central nervous system. Healthcare professionals can use the results of this study to understand that there is no evidence currently to support the utilisation of tDCS in improving exercise performance in athletes.
Abstract
Transcranial direct current stimulation (tDCS) has been used aiming to boost exercise performance and inconsistent findings have been reported. One possible explanation is related to the limitations of the so-called "conventional" tDCS, which uses large rectangular electrodes, resulting in a diffuse electric field. A new tDCS technique called high-definition tDCS (HD-tDCS) has been recently developed. HD-tDCS uses small ring electrodes and produces improved focality and greater magnitude of its aftereffects. This study tested whether HD-tDCS would improve exercise performance to a greater extent than conventional tDCS. Twelve endurance athletes (29.4 ± 7.3 years; 60.15 ± 5.09 ml kg-1 min-1) were enrolled in this single-center, randomized, crossover, and sham-controlled trial. To test reliability, participants performed two time to exhaustion (TTE) tests (control conditions) on a cycle simulator with 80% of peak power until volitional exhaustion. Next, they randomly received HD-tDCS (2.4 mA), conventional (2.0 mA), or active sham tDCS (2.0 mA) over the motor cortex for 20-min before performing the TTE test. TTE, heart rate (HR), associative thoughts, peripheral (lower limbs), and whole-body ratings of perceived exertion (RPE) were recorded every minute. Outcome measures were reliable. There was no difference in TTE between HD-tDCS (853.1 ± 288.6 s), simulated conventional (827.8 ± 278.7 s), sham (794.3 ± 271.2 s), or control conditions (TTE1 = 751.1 ± 261.6 s or TTE2 = 770.8 ± 250.6 s) [F(1.95; 21.4) = 1.537; P = 0.24; η2p = 0.123]. There was no effect on peripheral or whole-body RPE and associative thoughts (P > 0.05). No serious adverse effect was reported. A single session of neither HD-tDCS nor conventional tDCS changed exercise performance and psychophysiological responses in athletes, suggesting that a ceiling effect may exist.
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Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support.
Anton-Martin, P, Moreira, A, Kang, P, Green, ML
Cardiology in the young. 2020;(5):607-616
Abstract
OBJECTIVES To characterise the mortality and neurological outcomes of paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation and to identify risk factors associated with adverse outcomes in this population. MATERIALS AND METHODS Observational retrospective cohort study in paediatric cardiac patients undergoing cardiopulmonary resuscitation for greater than 30 minutes prior to cannulation in a tertiary children's hospital, from July 2000 to July 2013. RESULTS Seventy-three paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to cannulation were included in the study. Survival to hospital discharge was 43.8%, with 75% of survivors having either normal neurologic function or only mild disability. Multivariable logistic regression analysis demonstrated that increased use of calcium during resuscitation (odds ratio 14.5, p 0.01), cardiopulmonary resuscitation duration >50 minutes (odds ratio 4.12, p 0.03), >6 interruptions of chest compressions during cannulation (odds ratio 6.40, p 0.03), the need for continuous renal replacement therapy (odds ratio 11.1, p 0.001), and abnormal pupillary response during extracorporeal membrane oxygenation (odds ratio 33.9, p 0.006) were independent predictors for hospital mortality. CONCLUSION Survival after cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation in our paediatric cardiac cohort was 43.8%. Factors associated with mortality included calcium use during resuscitation, longer cardiopulmonary resuscitation, increased chest compression pauses during cannulation, the use of continuous renal replacement therapy, and abnormal pupils during extracorporeal membrane oxygenation support. A prospective assessment of these factors in paediatric cardiac patients may be beneficial in improving outcomes.
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The impact of exercise training on the lipid peroxidation metabolomic profile and respiratory infection risk in older adults.
Silva, D, Arend, E, Rocha, SM, Rudnitskaya, A, Delgado, L, Moreira, A, Carvalho, J
European journal of sport science. 2019;(3):384-393
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Abstract
UNLABELLED Aging is associated with oxidative stress that may increase susceptibility to respiratory infections (RIs). We aimed to assess the impact of exercise training on the risk of RIs in older adults and on a targeted metabolomic profile of stress oxidative lipid peroxidation-related metabolites. METHODS In an 8-month clinical trial, 38 participants over 60 years of age were allocated to an exercise group (EG), in which participants underwent 90-min training sessions three times/week(n = 20), or a control group (CG), in which participants maintained daily physical activities(n = 18). Daily respiratory symptoms and RIs number and severity were collected. Serum by-products were assessed by comprehensive two-dimensional gas chromatography coupled to mass spectrometry with time of flight analyzer. Serum metabolomic profiling comprised 76 metabolites (alcohols, aldehydes, alkanes, and ketones). Principal components analysis and ANOVA-simultaneous component analysis were used to evaluate the metabolomic profile change. RESULTS The odds ratio of RIs for the EG was 2.0 CI 95% [0.2;25]. The incidence of RIs was 47% [23;70] in the EG vs. 44%[12;77] in the CG. The metabolomic profiling showed that alkanes and aldehydes classes differed between the EG and the CG before and after intervention. A calibration model showed a relation between the metabolites from four main classes (ketones, alcohols, alkanes and aldehydes) and the prediction of the number of RIs. CONCLUSION Moderate exercise training, in older adults, compared with no exercise in controls, did not show a difference in the risk of RIs. A pattern of lipid peroxidation was associated with the number of RIs.