BACKGROUND.To determine the effects of preoperative exercise training on cardiorespiratory fitness in patients undergoing thoracic surgery for malignant lung lesions. METHODS.Using a single-group design, 25 patients with suspected operable lung cancer were provided with structured exercise training until surgical resection.Exercise training consisted of 5 endurance cycle ergometry sessions per week at intensities varying from 60% to 100% of baseline peak oxygen consumption (VO 2peak ). Participants underwent cardiopulmonary exercise testing, 6-minute walk (6MW), and pulmonary function testing at baseline, immediately before, and 30 days after surgical resection. RESULTS.Five patients were deemed ineligible before surgical resection and were removed from the analysis. Of the remaining 20 patients follow-up assessments were obtained for 18 (90%) before resection and 13 (65%) patients postresection.The overall adherence rate was 72%. Intention-to-treat analysis indicated that mean VO 2peak increased by 2.4 mL Á kg 21 Á min 21 (95% confidence interval [CI], 1.0-3.8; P 5 .002) and 6MW distance increased 40m (95% CI, 16-64; P 5 .003) baseline to presurgery. Per protocol analyses indicated that patients who attended !80% of prescribed sessions increased VO 2peak and 6MWD by 3.3 mL Á kg 21 Á min 21 (95% CI, 1.1-5.4; P 5 .006) and 49 meters (95% CI, 12-85; P 5 .013), respectively. Exploratory analyses indicated that presurgical exercise capacity decreased postsurgery, but did not decrease beyond baseline values. CONCLUSIONS.Preoperative exercise training is a beneficial intervention to improve cardiorespiratory fitness in patients undergoing pulmonary resection. This benefit may have important implications for surgical outcome and postsurgical recovery in this population. Larger randomized controlled trials are war-

Cardiac pacing is the only effective therapy for patients with symptomatic bradyarrhythmia. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, recurrent heart failure, and atrial arrhythmias. Physiological pacing activates the normal cardiac conduction, thereby providing synchronized contraction of ventricles. Though His bundle pacing (HBP) acts as an ideal physiological pacing modality, it is technically challenging and associated with troubleshooting issues during follow‐up. Left bundle branch pacing (LBBP) has been suggested as an effective alternative to overcome the limitations of HBP as it provides low and stable pacing threshold, lead stability, and correction of distal conduction system disease. This paper will focus on the implantation technique, troubleshooting, clinical implications, and a review of published literature of LBBP.

Since the approval of Olaparib by both FDA and EMA, further clinical trials continue to investigate the use of Olaparib and other PARP inhibitors. The anticipating outcome of these trials may clarify the benefit of PARP inhibitors in management of various BRCA mutated solid tumors.

Systemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis. The effects of interventions to lower inflammation have not been explored. Accordingly, we conducted a pilot study to explore the effects of exercise training on changes in biomarkers of systemic inflammation among patients with malignant lung lesions. Using a single-group design, 12 patients with suspected operable lung cancer were provided with structured exercise training until surgical resection. Participants underwent cardiopulmonary exercise testing, 6 min walk testing, pulmonary function testing, and blood collection at baseline and immediately prior to surgical resection. Systemic inflammatory markers included intracellular adhesion molecule (ICAM)-1, macrophage inflammatory protein-1alpha, interleukin (IL)-6, IL-8, monocyte chemotactic protein-1, C-reactive protein, and tumor necrosis factor-alpha. The overall exercise adherence rate was 78%, with patients completing a mean of 30 +/- 25 sessions. Mean peak oxygen consumption increased 2.9 mL.kg-1.min-1 from baseline to presurgery (p = 0.016). Results indicate that exercise training resulted in a significant reduction in ICAM-1 (p = 0.041). Changes in other inflammatory markers did not reach statistical significance. Change in cardiorespiratory fitness was not associated with change in systemic inflammatory markers. This exploratory study provides an initial step for future studies to elucidate the potential role of exercise, as well as identify the underlying mechanisms of action, as a means of modulating the relationship between inflammation and cancer pathogenesis.