Incidence and outcome of brain and/or leptomeningeal metastases in HER2-low metastatic breast cancer in the French ESME cohort

BACKGROUND

Breast cancer (BC) is the second most common cancer that metastasizes to the brain. Particularly up to half of patients with human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (mBC) may develop brain metastases over the course of the disease. Nevertheless, little is known about the prevalence and the outcome of brain and leptomeningeal metastases (BLMM) in HER2-low BC. We compared the cumulative incidence of BLMM and associated outcomes among patients with HER2-low, HER2-negative (HER2-) and HER2+ mBC.

PATIENTS AND METHODS

This cohort study was conducted from the Epidemiological Strategy and Medical Economics (ESME) mBC database and included patients treated for mBC between 2012 and 2020 across 18 French comprehensive cancer centers and with known HER2 and hormone receptor (HR) status. The cumulative incidence of BLMM after metastatic diagnosis was estimated using a competing risk methodology with death defined as a competing event.

RESULTS

19 585 patients were included with 6118 (31.2%), 9943 (50.8%) and 3524 (18.0%) being HER2-low, HER2- and HER2+ mBC, respectively. After a median follow-up of 48.6 months [95% confidence interval (CI) 47.7-49.3 months], BLMM were reported in 4727 patients: 1192 (25.2%) were diagnosed with BLMM at first metastatic diagnosis and 3535 (74.8%) after metastatic diagnosis. Multivariable analysis adjusted for age, histological grade, metastases-free interval and HR status showed that the risk of BLMM at metastatic diagnosis was similar in patients with HER2- compared to HER2-low mBC [odds ratio (OR) (95% CI) 1.00 (0.86-1.17)] and higher in those with HER2+ compared to HER2-low [OR (95% CI) 2.23 (1.87-2.66)]. Similar results were found after metastatic diagnosis; the risk of BLMM was similar in HER2- compared to HER2-low [subdistribution hazard ratio (sHR) (95% CI) 1.07 (0.98-1.16)] and higher in the HER2+ group [sHR (95% CI) 1.56 (1.41-1.73)].

CONCLUSIONS

The prevalence and evolution of BLMM in HER2-low mBC are similar to those in patients with HER2- tumors. In contrast to patients with HER2+ mBC, the prognosis of BLMM remains dismal in this population.

Reduced risk of secondary primary extra pulmonary cancer in advanced/metastatic lung cancer patients treated with immune checkpoint inhibitors

BACKGROUND

Lung cancer survivors are at high risk of developing a second primary cancer (SPC). We explored the Unicancer Epidemiology Strategy Medical-Economics for advanced or metastatic lung cancer (AMLC) database to assess the impact of immune checkpoint inhibitors (ICI) on the risk of SPC in patients with advanced/metastatic lung cancer.

PATIENTS AND METHODS

This retrospective study used data from patients with AMLC, with treatment initiated between January 1st 2015 and December 31st 2018. Patients with lung cancer as the second primary cancer were excluded and a 6-months landmark threshold was applied to exclude patients with synchronous SPC, patients dead without SPC or with a follow-up inferior to 6 months. A propensity score (PS) was calculated on the following baseline covariates: Age at locally advanced or metastatic diagnosis, sex, smoking status, metastatic status, performance status and histological type. The inverse probability of treatment weighting approach was used on the analyses aiming to assess the impact of ICI administered for AMLC, on the risk of occurrence of SPC.

RESULTS

Among the 10 796 patients, 148 (1.4%) patients had a diagnosis of SPC in a median interval of 22 (min-max: 7-173) months. All the patients (100%) with locally advanced or metastatic LC received at least one systemic treatment including (chemotherapy regimen (n = 9 851, 91.2%); ICI (n = 4 648, 43.0%); targeted treatment (n = 3 500; 32.4%). 40 (0.9%) SPC were reported in the 4 648 patients with metastatic LC treated with ICI vs 108 (1.7%) out of the 6 148 who did not receive immunotherapy (p < 0.0001). The multivariate analysis identified that treatment with ICI in patients with AMLC is associated with a reduced risk of SPC (HR = 0.40, 95% CI 0.27-0.58).

CONCLUSION

Treatment with ICI in AMLC patients was associated with a significantly reduced risk of SPC. Prospective studies are required to confirm these results.

High-intensity intermittent training is as effective as moderate continuous training, and not deleterious, in cardiomyocyte remodeling of hypertensive rats

Exercise training offers possible nonpharmacological therapy for cardiovascular diseases including hypertension. High-intensity intermittent exercise (HIIE) training has been shown to have as much or even more beneficial cardiovascular effect in patients with cardiovascular diseases than moderate-intensity continuous exercise (CMIE) training. The aim of this study was to investigate the effects of the two types of training on cardiac remodeling of spontaneously hypertensive rats (SHR) induced by hypertension. Eight-week-old male SHR and normotensive Wistar-Kyoto rats (WKY) were divided into four groups: normotensive and hypertensive control (WKY and SHR-C) and hypertensive trained with CMIE (SHR-T CMIE) or HIIE (SHR-T HIIE). After 8 wk of training or inactivity, maximal running speed (MRS), arterial pressure, and heart weight were all assessed. CMIE or HIIE protocols not only increased final MRS and left ventricular weight/body weight ratio but also reduced mean arterial pressure compared with sedentary group. Then, left ventricular tissue was enzymatically dissociated, and isolated cardiomyocytes were used to highlight the changes induced by physical activity at morphological, mechanical, and molecular levels. Both types of training induced restoration of transverse tubule regularity, decrease in spark site density, and reduction in half-relaxation time of calcium transients. HIIE training, in particular, decreased spark amplitude and width, and increased cardiomyocyte contractility and the expression of sarco(endo)plasmic reticulum Ca²⁺-ATPase and phospholamban phosphorylated on serine 16. NEW & NOTEWORTHY High-intensity intermittent exercise training induces beneficial remodeling of the left ventricular cardiomyocytes of spontaneously hypertensive rats at the morphological, mechanical, and molecular levels. Results also confirm, at the cellular level, that this type of training, as it appears not to be deleterious, could be applied in rehabilitation of hypertensive patients.

Reliability of Peak Exercise Stroke Volume Assessment by Impedance Cardiography in Patients with Residual Right Outflow Tract Lesions After Congenital Heart Disease Repair

Global ventricular response to exercise may be useful in follow-up of patients with residual right outflow tract lesions after congenital heart disease repair. In this context, impedance cardiography is considered accurate for stroke volume (SV) measurement during exercise testing, however, to date, only partial assessment of its reliability has been reported. We retrospectively evaluated relative and absolute reliability of peak SV by impedance cardiography during exercise using intraclass correlation (ICC) and standard error of measurement (SEM) in this population. Peak SV was measured in 30 young patients (mean age 14.4 years ± 2.1) with right ventricular outflow tract reconstruction who underwent two cardiopulmonary exercise tests at a mean one-year interval. SV was measured using a signal morphology impedance cardiography analysis device (PhysioFlow^®) and was indexed to body surface area. ICC of peak indexed SV measurement was 0.80 and SEM was 10.5%. High heterogeneity was seen when comparing patients according to peak indexed SV; in patients with peak SV < 50 ml/m² (15 patients), ICC rose to 0.95 and SEM dropped to 2.7%, while in patients with a peak SV > 50 ml/m² relative and absolute reliability decreased (ICC = 0.45, SEM = 12.2%). Peak exercise SV assessment by a PhysioFlow^® device represents a highly reliable method in patients with residual right outflow tract lesions after congenital heart disease repair, especially in patients with peak SV < 50 ml/m². In this latter group, a peak SV decrease > 7.3% (corresponding to the minimum "true" difference) should be considered a clinically-relevant decrease in global ventricular performance and taken into account when deciding whether to perform residual lesion removal.

[High blood pressure and physical exercise]

High blood pressure is a frequent pathology with many cardiovascular complications. As highlighted in guidelines, the therapeutic management of hypertension relies on non-pharmacological measures, which are diet and regular physical activity, but both patients and physicians are reluctant to physical activity prescription. To acquire the conviction that physical activity is beneficial, necessary and possible, we can take into account some fundamental and clinical studies, as well as the feedback of our clinical practice. Physical inactivity is a major risk factor for cardiovascular morbidity and mortality, and hypertension contributes to increase this risk. Conversely, regular practice of physical activity decreases very significantly the risk by up to 60%. The acute blood pressure changes during exercise and post-exercise hypotension differs according to the dynamic component (endurance or aerobic and/or strength exercises), but the repetition of the sessions leads to the chronic hypotensive benefit of physical activity. Moreover, physical activity prescription must take into account the assessment of global cardiovascular risk, the control of the hypertension, and the opportunities and desires of the patient in order to promote good adherence and beneficial lifestyle change.

Locomotor performance in highly-trained young soccer players: does body size always matter?

To examine the effects of body size on locomotor performance, 807 15-year-old French and 64 Qatari soccer players participated in the present study. They performed a 40-m sprint and an incremental running test to assess maximal sprinting (MSS) and aerobic speeds, respectively. French players were advanced in maturity, taller, heavier, faster and fitter than their Qatari counterparts (e.g., Cohen's d=+1.3 and + 0.5 for body mass and MSS). However, when adjusted for body mass (BM), Qatari players had possibly greater MSS than French players (d=+0.2). A relative age effect was observed within both countries, with the players born in the first quarter of the year being taller, heavier and faster that those born during the fourth quarter (e.g., d=+0.2 for MSS in French players). When directly adjusted for BM, these MSS differences remained (d=+0.2). Finally, in both countries, players selected in National teams were taller, heavier, faster and fitter than their non-selected counterparts (e.g., d=+0.6 for MSS in French players), even after adjustments for body size (d=+0.5). Differences in locomotor performances between players with different phenotypes are likely mediated by differences in body size. However, when considering more homogeneous player groups, body dimensions are unlikely to substantially explain the superior locomotor performances of older and/or international players.

Effect of training cessation on muscular performance: a meta-analysis

The purpose of this study was to assess the effect of resistance training cessation on strength performance through a meta-analysis. Seven databases were searched from which 103 of 284 potential studies met inclusion criteria. Training status, sex, age, and the duration of training cessation were used as moderators. Standardized mean difference (SMD) in muscular performance was calculated and weighted by the inverse of variance to calculate an overall effect and its 95% confidence interval (CI). Results indicated a detrimental effect of resistance training cessation on all components of muscular performance: [submaximal strength; SMD (95% CI) = -0.62 (-0.80 to -0.45), P < 0.01], [maximal force; SMD (95% CI) = -0.46 (-0.54 to -0.37), P < 0.01], [maximal power; SMD (95% CI) = -0.20 (-0.28 to -0.13), P < 0.01]. A dose-response relationship between the amplitude of SMD and the duration of training cessation was identified. The effect of resistance training cessation was found to be larger in older people (> 65 years old). The effect was also larger in inactive people for maximal force and maximal power when compared with recreational athletes. Resistance training cessation decreases all components of muscular strength. The magnitude of the effect differs according to training status, age or the duration of training cessation.

VO2 slow component is independent from critical power

The aim of this study was to determine whether the amplitude of the V˙O (2) slow component was dependent from Critical Power (CP; the slope of the linear time - distance relationship) in individuals matched for V˙O (2) peak. 30 moderately-trained endurance athletes completed a maximal graded exercise test, 2 randomly ordered constant power tests at 90 and 100% of peak power output (PPO), and 2 constant duration test of 6 min at 30% of the difference between CP and PPO. Afterwards, participants were ranked according to their relative CP (%PPO; a direct measure of aerobic endurance). The median third was excluded to form a low aerobic endurance group (LEG) and a high aerobic endurance group (HEG). A t-test revealed no difference between LEG and HEG in peak oxygen consumption, but a large difference in their relative CP (p<0.001, effect size=3.2). A' (2) was similar between groups (626 ± 96 and 512 ± 176 ml, corresponding to 26 ± 4 and 24 ± 8% of end exercise oxygen consumption, respectively; NS) and was not associated with relative CP (r=0.10; NS). These results suggest that increasing CP probably extends the range of exercise intensities over which the V˙O (2) slow component does not develop, but does not decrease the amplitude of this phenomenon once it occurs.

Effect of functional overreaching on executive functions

The aim of this study was to investigate whether cognitive performance was a valid marker of overreaching. 10 well-trained male endurance athletes increased their training load by 100% for 2 weeks. They performed a maximal graded test, a constant speed test, a reaction time task and a computerized version of the Stroop color word-test before and after this overload period. Regarding performance results, five participants were considered as overreached and the five remaining were considered as well-trained. We found no significant differences between groups in performing the Stroop test. Noteworthy, we found a small increase in response time in the more complex condition in overreached athletes (1 188+/-261 to 1 297+/-231 ms, effect size=0.44), while it decreased moderately in the well-trained athletes (1 066+/-175 to 963+/-171 ms, effect size=-0.59). Furthermore, we found an interaction between time and group on initiation time of the reaction time task, since it increased in overreached athletes after the overload period (246+/-24 to 264+/-26 ms, p<0.05), while it remained unchanged in well-trained participants. Participants made very few anticipation errors, whatever the group or the period (error rate <2%).We concluded that an unaccustomed increase in training volume which is accompanied by a decrement in physical performance induces a deterioration of some executive functions.

Anaerobic Work Capacity derived from isokinetic and isoinertial cycling

The purpose of this study was to compare Anaerobic Work Capacity (AWC) measured on an isoinertial or an isokinetic bicycle ergometer. Twelve male participants completed two randomly ordered exercise testing sessions including a torque-velocity test followed by a 30-s all-out test on an isokinetic ergometer, or a force-velocity test followed by a Wingate Anaerobic Test on an isoinertial ergometer. Optimal load measured during the force-velocity test on the isoinertial ergometer was 1.13+/-0.11 N.kg(-1). Optimal cadence measured during the torque-velocity test on the isokinetic ergometer was 107+/-13 rpm. Although P(peak) measures were significantly correlated (r=0.77), we found a large difference between them (effect size=2.85) together with wide limits of agreement (bias+/-95%LOA=24+/-12%). The same observation was made with P(mean), but with a smaller magnitude of difference (bias+/-95%LOA=4.2+/-12%; effect size=0.51; r=0.73). This lack of agreement led us to the conclusion that AWC measures obtained during 30-s all-out tests performed on an isoinertial or an isokinetic bicycle ergometer are not necessarily similar and cannot be used interchangeably.

Effect of the lengthening of the protocol on the reliability of muscle fatigue indicators

The aim of this study was to examine absolute and relative reliability of fatigue measures calculated from peak torque or total work during 20, 30, 40 and 50 reciprocal maximal concentric contractions performed on an isokinetic dynamometer at 180 degrees x s(-1). Eighteen moderately active men performed 50 reciprocal maximal concentric contractions on three occasions with one 7-10 days recovery between each session. Peak torque and total work were computed for each contraction and subsequently summed to compute cumulated performance after respectively 20, 30, 40 and 50 repetitions. Muscle fatigue was determined after 20, 30, 40 and 50 repetitions by the fatigue index, the percent decrease in performance and the slope. Reliability of average peak torque or average total work was similar and was not affected by the lengthening of the protocol, although a learning effect was evident for knee flexors. Reliability of fatigue measures calculated from peak torque or total work was similar, improved with the lengthening of the protocol and was better for knee extensors. Measuring average peak torque or average total work and the slope during a protocol involving 30 maximal reciprocal concentric contractions appear to represent a better compromise between reliability and physiological interpretability of the data.

Reliability of Postexercise Heart Rate Recovery

Passive postexercise heart rate (HR) recovery is currently used in the assessment of endurance athletes to determine changes in performance or in the clinical setting as a predictor of all-cause mortality. The purpose of this investigation was to assess the reliability of HR recovery. Thirty healthy subjects performed two maximal and two submaximal treadmill exercises, followed by 5 minutes of passive recovery. HR signal was used to compute raw and Delta (exercise - recovery) HR after 1, 2, 3, and 5 minutes of exercise cessation. A mono-exponential function was fitted to the data using the least squares procedure. We found no significant bias between repeated measures. Relative reliability was lower for Delta HR when compared with raw HR (0.43 < ICC < 0.71 vs. 0.68 < ICC < 0.83, respectively). Absolute reliability was relatively constant over time for raw HR (SEM = approximately 8 %), while it decreased exponentially from the 1st (SEM = approximately 20 %) to the 5th minute of recovery (SEM = approximately 8 %) for Delta HR. The reliability of parameter estimates from exponential curve fitting was less consistent, since both ICC (0.43 to 0.88) and SEM (5.7 to 21.4 %) differed from one parameter to the other according to the intensity of exercise. We conclude that passive postexercise HR recovery reliability is heterogeneous. Raw HR is the desired method to describe it.

Validity of the Polar S810 to Measure R-R Intervals in Children

Intervals between two consecutive cardiac beats (R-R intervals) and the subsequent analysis of heart rate variability (HRV) obtained simultaneously from the Polar S810 heart rate monitor (HRM) and an electrocardiogram (ECG) in a supine position were compared in twelve children (age 9.6 +/- 0.9 years) before and after protocol correction. R-R intervals were significantly different between the ECG and the HRM uncorrected and corrected signal (p < 0.001, effect size [ES] = 0.005, and 0.005, respectively). However, the bias (95 % confidence interval) was 0.80 (- 124.76 - 123.16) ms and 0.80 (- 12.76 - 11.16) ms, respectively. HRV parameters derived from both signals were not different (p > 0.05) and well correlated (r > 0.99, p < 0.05), except SD2 (p < 0.05, ES = 0.000; r = 0.99). These data support the validity of the Polar S810 HRM to measure R-R intervals and make the subsequent HRV analysis in a supine position in children.

Effect of Training and Detraining on Heart Rate Variability in Healthy Young Men

The purpose of this study was to investigate the effect of twelve weeks of aerobic training and eight weeks of training cessation on Heart Rate Variability (HRV). Ten healthy young men (Age: 21.7 +/- 2.2 years; Height: 179.2 +/- 6.9 cm; Mass 72.7 +/- 11.1 kg) completed an incremental test and a 60 degrees tilt test during which R-R intervals were recorded before (T0) and after (T12) 12 weeks of intensive training, and after 2, 4 and 8 weeks of training cessation (D2, D4 and D8, respectively). HRV was computed in time and frequency domains. Training resulted in a significant increase in estimated VO2max after T12 (p < 0.01), followed by a significant decrease during D2 and D8 (p < 0.05). Total power (LF + HF) and low frequency power (LF) increased significantly in the supine position after the training period (p < 0.05) and decreased moderately after D2 (p > 0.05) to stabilize afterwards. LF + HF and LF were not different from T0 at D8 (p > 0.05). It was concluded that eight weeks of training cessation allow to reverse the cardiovascular autonomic adaptations induced by 12 weeks of intensive training in healthy young men.

Anaerobic Running Capacity Determined from a 3-Parameter Systems Model: Relationship with other Anaerobic Indices and with Running Performance in the 800 m-Run

The purpose of this study was to compare anaerobic running capacity (ARC, i.e., the distance that can be run using only stored energy sources in the muscle) determined from a 3-parameter systems model with other anaerobic indices and with running performance in the 800 m. Seventeen trained male subjects (.VO(2max) = 66.54 +/- 7.29 ml . min (-1) . kg (-1)) performed an incremental test to exhaustion for the determination of .VO(2max) and peak treadmill velocity (PTV), five randomly ordered constant velocity tests at 95, 100, 105, 110, and 120 % of PTV to compute ARC and oxygen deficit (O(2)def, at 110 % of PTV), and a 800-m time trial to determine running performance (mean velocity over the distance, V (800 m)) and peak blood lactate concentration ([La (-)] (b, peak)). ARC (467 +/- 123 m) was positively correlated with O(2)def (56.35 +/- 18.47 ml . kg (-1); r = 0.57; p < 0.05), but not with [La (-)] (b, peak) (15.08 +/- 1.48 mmol . l (-1); r = - 0.16; p > 0.05). The O(2) equivalent of ARC (i.e., the product of ARC by the energy cost of running; 103.74 +/- 28.25 ml . kg (-1)), which is considered as an indirect estimation of O(2)def, was significantly higher than O(2)def (p < 0.01, effect size = 1.99). It was concluded that ARC is partially determined by anaerobic pathway, but that it probably does not provide an accurate measure of anaerobic capacity, if, however, O(2)def can be considered as a criterion measure for it.

V·O2 Kinetics during Supramaximal Exercise: Relationship with Oxygen Deficit and 800-m Running Performance

The aim of this study was to compare .VO2 kinetics of highly- versus recreationally-trained subjects during a constant velocity test of supramaximal intensity. Eighteen trained male subjects were recruited to one of two groups: highly trained (HT, n = 8, .VO(2max) = 70.1 +/- 6.5 ml . min (-1) . kg (-1)) and recreationally trained (RT, n = 10, .VO(2max) = 63.2 +/- 6.4 ml . min (-1) . kg (-1)). All subjects performed an incremental test to exhaustion for the determination of .VO(2max) and peak treadmill velocity (PTV), two constant velocity tests at 110 % of PTV to determine .VO2 kinetics and oxygen deficit (O(2)def), and a 800-m time trial to determine running performance (mean velocity over the distance, V (800 m)). We found significant differences between HT and RT for the on-transient of the .VO2 response (tau, 24.7 +/- 3.3 and 30.9 +/- 7.0 s, respectively), the amplitude of the .VO2 response (60.0 +/- 5.0 and 53.5 +/- 5.7 ml . min (-1) . kg (-1), respectively) and V (800 m) (6.27 +/- 2.1 and 5.45 +/- 0.38 m . s (-1), respectively). O(2)def (24.6 +/- 2.7 and 27.7 +/- 7.8 ml . kg (-1), respectively) and the gain of the .VO2 response (193 +/- 14 and 194 +/- 13 ml . kg (-1) . m (-1), respectively) were similar between groups. tau was associated with O(2)def (r = 0.90, p < 0.05), but not with V (800 m) (r = 0.30, p > 0.05). It was concluded that HT subjects exhibited faster on-kinetics and higher amplitude than their RT counterparts. The higher amplitude was not thought to reflect any difference in underlying physiological mechanisms. The faster tau, whose exact mechanisms remain to be elucidated, may have practical implications for coaches.

Reproducibility of Performance in Three Types of Training Test in Swimming

A variety of testing procedures are used to assess the effects of particular treatments on the training status of athletes. The present study aims to investigate the reproducibility of selected tests in swimming. Sixteen trained swimmers performed three kinds of test: 1) Constant Distance Test (CDT), 2) Constant Time Test (CTT), and 3) Constant Velocity Test (CVT). The analysis of the reproducibility was based on a test-retest procedure. The test-retest performances were highly correlated for the three kinds of test (r = 0.98, 0.98, and 0.93 for CDT, CTT and CVT, respectively). The mean Coefficient of Variation (CV) was computed between test-retest for each subject and each procedure. A repeated measures one-way ANOVA showed that CVT was significantly less reliable (CV = 6.46 +/- 6.24 %) than CDT and CTT (CV = 0.56 +/- 0.6 0 % and 0.63 +/- 0.54 % respectively) (p < 0.001). Psychological factors and a lack of familiarity with CVT (not extensively used during training session) could explain its greater variability. Thus, CDT and CTT seem to be the most reliable tests to detect the smallest meaningful change in the training status of swimmers. Post-hoc power calculations of the experimental design showed the sample size would have to increase to 80, 113, and 228 subjects for CWT, CDT and CPT respectively, to reach a power of 80 %. The minimal detectable differences have to be calculated to ensure a real effect of a particular treatment on a group of swimmers, according to the kind of test used.

[2005 monitoring report: use of positron emission tomography with fluorodeoxyglucose in the management of patients with breast cancer, ovarian cancer, and uterine cancer]

CONTEXT

The validity of the recommendations is based on their actualisation as well as on the quality of the initial elaboration process. Therefore the "Standards, Options and Recommendations" (SOR) from the National French federation of comprehensive cancer centres (FNCLCC) has set up a literature monitoring process.

OBJECTIVES

To identify new data, which are likely to modify existing recommendations, evaluate their impact and inform potential users on their validity.

METHODS

The monitoring process is based on 3 main steps lead in collaboration with experts: collect data, select and classify information and analyse information. Analysis of information consists of comparing the conclusions of new data with the conclusions of the initial report and then to identify the recommendations that need to be updated.

RESULTS

This article presents the 2005 monitoring report concerning "the use of positron emission tomography with FDG in the management of breast cancer, ovarian cancer and uterin cancer". Following the monitoring process,all the existing recommendations (initial report from 2003) are still valid. However three modifications have been proposed by the working group: 1) increased level of evidence concerning the use of PET-scan for suspicion of local or metastatic recurrence (option, level of evidence: A); 2) a new option for the use of PET-scan for revealed cervix cancer recurrence, especially for the therapeutic decision strategy (level of evidence: B2); and 3) new formulation (less strict) of the recommendation concerning the use of PET-scan in the management of endometrial cancer.

Preferred pedal rate: an index of cycling performance

The purpose of this study was to determine whether preferred pedal rate (PPR) could be used as an index of cycling performance. Thirteen competitive cyclists cycled at PPR during a graded test and a supra-threshold constant power test (CPT). The results showed that PPR values reported in CPT were correlated to both peak power determined from the graded test and exhaustion time assessed in CPT. Furthermore, multiple regression revealed that PPR values and P (peak) were two predictors of exhaustion time in CPT. Hence, this study suggests that coaches and sports scientists have to take into account PPR values complementary to P (peak) in order to evaluate the capacity of cycling performance.

Évaluation de l’activité physique quotidienne de patients adultes atteints de mucoviscidose

BACKGROUND

Cystic fibrosis (CF) patients often have a good level of daily activity contrasting with the impairment of pulmonary functions. The aim of this prospective study was to measure physical daily activity (PDA) in CF-patients and compare it with rest pulmonary functions and exercise tolerance.

MATERIAL AND METHODS

Fifteen CF-patients and 9 control subjects have been recruted. PDA was measured during 7 days using an accelerometer: Global-PDA (daily mean counts per day), percentage of inactivity (1 to 2 METS), light activity (2 to 3 METS), and moderate-to-hard activity (greater than 3 METS). Spirometry (FEV1, Vital Capacity) and clinical exercice testing (VO2, workload) were also performed.

RESULTS

Global-PDA of CF-patients was lower than control subjects (p < 0.05). Light activity (15.5 +/- 3.3% vs 13.4 +/- 2.4%) and inactivity (81.2 +/- 9% vs 79.9 +/- 3.1%) were similar in both groups. Only moderate-to-hard activity was greater in control subjects than in CF-patients (6.7 +/- 1.6% vs 3.3 +/- 3.4%; p < 0.05). There were correlations between Global-PDA and moderate-to-hard activity (r = 0.94), FEV1 (r = 0.72), Vital Capacity (r = 0.77), workload peak (r = 0.88), and VO2peak (r = 0.70).

CONCLUSION

CF-patients have a lower PDA than control subjects because of a lower moderate-to-hard activity (>3 METS). In clinical practice, interviewing a CF-patient on his "run-life" PDA (<3 METS) has poor relationship with his real "moderate-to-hard activity", and this is a confusing factor for clinicians.

[Clinical practice guidelines: 2004 Standards, Options and Recommendations for the management of patient with adenocarcinoma of the stomach--radiotherapy]

CONTEXT

"The Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French regional cancer centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients.

OBJECTIVES

To elaborate clinical practice guidelines for patients with stomach adenocarcinoma. These recommendations cover the diagnosis, treatment and follow-up of these tumors.

METHODS

The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. The Standards, Options and Recommendations are thus based on the best available evidence and expert agreement.

RESULTS

Adjuvant radiation therapy alone is not a standard treatment for patients with stomach adenocarcinoma. Adjuvant concomitant chemoradiotherapy is not a standard treatment for patients with stage II or III stomach adenocarcinoma R0, with Dl or D2 lymphadenectomy who have undergone surgery. Following surgical resection, adjuvant concomitant chemoradiotherapy should be proposed to patients without denutrition with a lymphadenectomy < Dl (fewer than 15 lymph nodes examined) and those with T3 and/or N+ tumours following the protocol used in the MacDonald trials (SWOG-9008) (Level of evidence B1). Adjuvant concomitant chemoradiotherapy can be administered to patients without denutrition with DI or D2 lymphadenectomy and with involvement of regional lymph nodes (N2 or N3).

Night heart rate variability during overtraining in male endurance athletes

AIM

The purpose of the study was to examine whether an unaccustomed increase in training volume would result in characteristics changes in heart rate variability (HRV), in order to determine if this marker can be used to diagnose overtraining.

METHODS

Nine experienced endurance athletes increased their usual amount of training by 100% within 4 weeks. Night ECG was recorded before (baseline) and after (OVER) this period of overload, and after 2 weeks of recovery (REC).

RESULTS

We diagnosed overtraining in 6 subjects using both physiological and psychological criteria. No difference was noted in heart rate for night periods (56+/-12, 55+/-10 and 53+/-15 bpm, respectively; p>0.05). We found no significant changes of LF/HF (1.10+/-0.92, 0.96+/-0.57 and 0.59+/-0.43, respectively; p>0.05) or HF expressed in normalized units (54.81+/-20.12, 53.81+/-11.35 and 66.15+/-15.12%, respectively; p>0.05).

CONCLUSION

In the conditions of the present study, HRV during sleep does not seem to be a valid marker of overtraining in male endurance athletes. Before concluding to the uselessness of this tool in the monitoring of the syndrome, longitudinal studies with elite or sub-elite athletes are needed to determine if spontaneously developed overtraining results in the same response.