BackgroundPhysical exercise and nutritional treatment are promising measures to prevent muscle wasting that is frequently observed in advanced-stage cancer patients. However, conventional exercise is not always suitable for these patients due to physical weakness and therapeutic side effects. In this pilot study, we examined the effect of a combined approach of the novel training method whole-body electromyostimulation (WB-EMS) and individualized nutritional support on body composition with primary focus on skeletal muscle mass in advanced cancer patients under oncological treatment.MethodsIn a non-randomized controlled trial design patients (56.5% male; 59.9 ± 12.7 years) with advanced solid tumors (UICC III/IV, N = 131) undergoing anti-cancer therapy were allocated to a usual care control group (n = 35) receiving individualized nutritional support or to an intervention group (n = 96) that additionally performed a supervised physical exercise program in form of 20 min WB-EMS sessions (bipolar, 85 Hz) 2×/week for 12 weeks. The primary outcome of skeletal muscle mass and secondary outcomes of body composition, body weight and hand grip strength were measured at baseline, in weeks 4, 8 and 12 by bioelectrical impedance analysis and hand dynamometer. Effects of WB-EMS were estimated by linear mixed models. Secondary outcomes of physical function, hematological and blood chemistry parameters, quality of life and fatigue were assessed at baseline and week 12. Changes were analyzed by t-tests, Wilcoxon signed-rank or Mann-Whitney-U-tests.ResultsTwenty-four patients of the control and 58 of the WB-EMS group completed the 12-week trial. Patients of the WB-EMS group had a significantly higher skeletal muscle mass (0.53 kg [0.08, 0.98]; p = 0.022) and body weight (1.02 kg [0.05, 1.98]; p = 0.039) compared to controls at the end of intervention. WB-EMS also significantly improved physical function and performance status (p < 0.05). No significant differences of changes in quality of life, fatigue and blood parameters were detected between the study groups after 12 weeks.ConclusionsSupervised WB-EMS training is a safe strength training method and combined with nutritional support it shows promising effects against muscle wasting and on physical function in advanced-stage cancer patients undergoing treatment.Trial registrationClinicalTrials.gov NCT02293239 (Date: November 18, 2014).

BackgroundTo better understand the relative effects of infection with nontuberculous mycobacteria and Gram negative bacteria on lung function decline in cystic fibrosis, we assessed the impact of each infection in a Danish setting.MethodsLongitudinal registry study of 432 patients with cystic fibrosis contributing 53,771 lung function measures between 1974 and 2014. We used a mixed effects model with longitudinally structured correlation, while adjusting for clinically important covariates.ResultsInfections with a significant impact on rate of decline in %FEV1 were Mycobacterium abscessus complex with − 2.22% points per year (95% CI − 3.21 to − 1.23), Burkholderia cepacia complex − 1.95% (95% CI − 2.51 to − 1.39), Achromobacterxylosoxidans − 1.55% (95% CI − 2.21 to − 0.90), and Pseudomonas aeruginosa − 0.95% (95% CI − 1.24 to − 0.66). Clearing M. abscessus complex was associated with a change to a slower decline, similar in magnitude to the pre-infection slope.ConclusionsIn a national population we have demonstrated the impact on lung function of each chronic CF pathogen. M. abscessus complex was associated with the worst impact on lung function. Eradication of M. abscessus complex may significantly improve lung function.

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in University of Innsbruck AbstractQuantile regression provides a convenient framework for analyzing the impact of covariates on the complete conditional distribution of a response variable instead of only the mean. While frequentist treatments of quantile regression are typically completely nonparametric, a Bayesian formulation relies on assuming the asymmetric Laplace distribution as auxiliary error distribution that yields posterior modes equivalent to frequentist estimates. In this paper, we utilize a location-scale-mixture of normals representation of the asymmetric Laplace distribution to transfer different flexible modeling concepts from Gaussian mean regression to Bayesian semiparametric quantile regression. In particular, we will consider high-dimensional geoadditive models comprising LASSO regularization priors and mixed models with potentially non-normal random effects distribution modeled via a Dirichlet process mixture. These extensions are illustrated using two large-scale applications on net rents in Munich and longitudinal measurements on obesity among children.

Aim Spatial environmental heterogeneity (EH) is an important driver of species richness, affecting species coexistence, persistence and diversification. EH has been widely studied in ecology and evolution and quantified in many different ways, with a strong bias towards a few common measures of EH like elevation range. Here, we calculate 51 measures of EH within grid cells world‐wide across three spatial grains to investigate similarities and differences among these measures. Moreover, we compare the association between species richness of terrestrial mammals and each EH measure to assess the impact of methodological choices on EH–richness relationships found by standard macroecological modelling approaches. Location Global. Methods We derive 51 measures of EH from nine variables related to the five subject areas land cover, vegetation, climate, soil and topography, using nine calculation methods. We first explore differences among these EH measures with correlation and principal components analyses. We then analyse the relationship between mammal species richness and each EH measure alone and while accounting for effects of current climate, regional biogeographic history and human influence. We assess the impact of subject area and method of calculation of EH measures on model support using conditional inference trees. Results Despite some redundancy, correlations (rs = −0.45 to 1.00, median 0.35) and spatial patterns indicate clear differences between the EH measures. We find clear effects of subject area and calculation method on the importance of EH measures for mammal species richness. Measures of climatic and topographic EH and measures calculated as counts and ranges (as against, for example, coefficient of variation) receive particularly high model support across all spatial grains. Main conclusions The outcome of broad‐scale EH–richness studies is greatly determined by methodological decisions on calculation of measures and statistical analysis. These decisions should therefore be made carefully with regard to the hypothesis and mechanism of interest.

BackgroundDifferent measures of non-adherence to immunosuppressant (IS) medication have been found to be associated with rejection episodes after successful transplantation. The aim of the current study was to investigate whether graft rejection after renal transplantation is associated with patient-reported IS medication non-adherence and IS trough level variables (IS trough level variability and percentage of sub-therapeutic IS trough levels).MethodsPatient-reported non-adherence, IS trough level variability, percentage of sub-therapeutic IS trough levels, and acute biopsy-proven late allograft rejections were assessed in 267 adult renal transplant recipients who were ≥12 months post-transplantation.ResultsThe rate of rejection was 13.5%. IS trough level variability, percentage of sub-therapeutic IS trough levels as well as patient-reported non-adherence were all significantly and positively associated with rejection, but not with each other. Logistic regression analyses revealed that only the percentage of sub-therapeutic IS trough levels and age at transplantation remained significantly associated with rejection.ConclusionsParticularly, the percentage of sub-therapeutic IS trough levels is associated with acute rejections after kidney transplantation whereas IS trough level variability and patient-reported non-adherence seem to be of subordinate importance. Patient-reported non-adherence and IS trough level variables were not correlated; thus, non-adherence should always be measured in a multi-methodological approach. Further research concerning the best combination of non-adherence measures is needed.