Cachexia is a syndrome characterized by involuntary weight loss and wasting of skeletal muscle mass. It is associated with worse overall survival and quality of life. The cancer‐induced systemic inflammation and the consequent host derived catabolic stimuli, trigger cachexia by inhibiting muscle protein synthesis and enhancing muscle catabolism. The muscle itself may further promote chronic inflammation, introducing a vicious catabolic circle. Nutritional support alone plays a limited role in the treatment of cancer cachexia and should be combined with other interventions. Physical exercise lowers systemic inflammation and promotes muscle anabolism. It also attenuates the age‐related physical decline in elderly and it might counteract the muscle wasting induced by the cancer cachexia syndrome. This review describes how cancer‐induced systemic inflammation promotes muscle wasting and whether physical exercise may represent a suitable treatment for cancer‐induced cachexia, particularly in patients with non‐small cell lung cancer. We summarized pre‐clinical and clinical studies investigating whether physical exercise would improve muscle performance and whether this improvement would translate in a clinically meaningful benefit for patients with cancer, in terms of survival and quality of life. Moreover, this review describes the results of studies investigating the interplay between physical exercise and the immune system, including the role of the intestinal microbiota.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jcsm.12900

Physical exercise at the crossroad between muscle wasting and the immune system: implications for lung cancer cachexia

Low serum 25-hydroxyvitamin D [25(OH)D] is linked to an altered lipid profile. Monocytes play an important role in inflammation and lipid metabolism. Recently, monocyte percentage to HDL-cholesterol ratio (MHR) has emerged as a novel marker of inflammation. We investigated the association between serum 25(OH)D concentrations and MHR and serum lipids in young healthy adults. Data from the Qatar Biobank were utilized to investigate the relation between serum 25(OH)D and inflammation and serum lipid concentrations in healthy Qatari adults using multivariate regression analysis. Prevalence of serum 25(OH)D concentrations <12 ng/mL (deficiency), 12-20 ng/mL (insufficiency), and ≥20 ng/mL (sufficiency) were 55.8%, 29.9%, and 14.3%, respectively. Serum 25(OH)D was significantly inversely associated with monocyte percentage, MHR, total cholesterol, LDL-cholesterol, and triacylglycerol in multivariable adjusted analysis. MHR could be a potential biomarker to predict cardiometabolic diseases among young healthy Qataris.

Serum 25-Hydroxyvitamin D Is Inversely Associated with Monocyte Percentage to HDL Cholesterol Ratio among Young Healthy Adults in Qatar.

This study aimed to investigate the correlation between monocyte to high-density lipoprotein cholesterol ratio (MHR) and obstructive sleep apnea (OSA) in patients with hypertension. A total of 246 hypertensive patients (67 controls, 65 mild, 51 moderate, and 63 severe OSA) were included. The relationship between MHR and OSA was analyzed. MHR correlated positively with apnea-hypopnea index (AHI), while negatively with mean SpO2 (P < 0.01). MHR was higher in OSA group than the control group (9.2 ± 2.6 vs. 10.8 ± 3.6, P < 0.001). Moreover, MHR in severe OSA group was the highest among all groups (9.2 ± 2.6, 10.2 ± 3.2, 10.4 ± 4.0, and 11.8 ± 3.4 in control, mild, moderate, and severe OSA group, respectively, P < 0.001). Logistic regression analysis demonstrated that MHR was an independent predictor of the presence of OSA (OR = 1.152, P < 0.01) and severe OSA (OR = 1.142, P < 0.01). Area under the curve of MHR was 0.634 (P < 0.05) and 0.660 (P < 0.05) for predicting OSA and severe OSA respectively in the ROC analysis. In conclusion, MHR increased with the severity of OSA. As a practical and cost-effective test, MHR was expected to be an available marker in evaluating OSA risk and severity in hypertensive patients.

/pdf/monocyte-to-hdl-cholesterol-ratio-as-a-marker-of-the-1i05bw6s7g.pdf

Monocyte to HDL cholesterol ratio as a marker of the presence and severity of obstructive sleep apnea in hypertensive patients

Pulmonary rehabilitation (PR) is fundamental in the management of chronic obstructive pulmonary disease (COPD). COPD patients show a large clinical heterogeneity that may influence their response to PR. Identification of homogeneous clusters of patients who may or may not respond to PR is important to personalize patient care. This study aimed at identifying distinct clinical phenotypes of COPD patients and assessing their respective 6-min walking distance (6MWD) response to in-patient PR.This is a cohort-based analysis of COPD patients admitted to a PR center between January 2012 and December 2017. Pre-PR patients' characteristics, lung function and 6-min walking test parameters were introduced in a hierarchical ascending clustering approach to identify distinct clusters.Out of 835 patients, 4 distinctive clusters were identified. The most likely to show clinically significant 6MWD improvement post-PR (responders) were cluster 1 (younger men, GOLD I-II, average walkers, obese; non-response rate: 16%), cluster 2 (older women, GOLD II-III, slow walkers; 18%), and cluster 3 (older men, GOLD II-III, dyspneic, slow walkers; 11%). The most likely to be non-responders were cluster 4 (older men, GOLD III-IV, dyspneic, very slow walkers, oxygen-dependent; 26%).Our data identified homogeneous patient clusters representing clinically relevant subgroups of COPD patients regarding their 6MWD response to PR. Clusters having the largest probability of being non-responders were older, more severe, with severe oxygen desaturation and dyspnea, limited 6MWD and requiring long-term oxygen therapy. These results may improve patient phenotyping in clinical practice and allow individualization of therapy. 

http://manuscript.elsevier.com/S0954611122001263/pdf/S0954611122001263.pdf

Clustering of COPD patients and their response to pulmonary rehabilitation.

OBJECTIVE
To evaluate the efficacy of aerobic training, resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease.


DESIGN
Randomized controlled trial.


SETTING
The Fourth Rehabilitation Hospital of Shanghai, China.


PARTICIPANTS
82 (67.0  ±  6.5 years, 59.8% male) patients with stable chronic obstructive pulmonary disease were randomized to intervention group 1 (n  =  27), intervention group 2 (n  =  28), and control group (n  =  27).


INTERVENTION
Intervention group 1 received aerobic and resistance training, while intervention group 2 received additional external diaphragm pacing. Control group received aerobic training only.


MAIN MEASURES
1-year follow-up of physical activity, body composition, respiratory function and diaphragm function.


RESULTS
Intervention groups 1 and 2 showed statistically improvements in the difference value compared with control group in terms of 6-min walk distance (-95.28  ±  20.09 and -101.92  ±  34.91 vs -63.58  ±  23.38), forced expiratory volume in 1 s (-0.042  ±  0.027 and -0.130  ±  0.050 vs -0.005  ±  0.068), fat-free mass (-2.11  ±  3.74 and -3.82  ±  3.74vs 0.28  ±  1.49) and chronic obstructive pulmonary disease assessment test value (2.16  ±  0.85 and 2.38  ±  1.02 vs 1.50  ±  0.93). Intervention group 2 showed significant difference in arterial oxygen pressure (-4.46  ±  3.22 vs -1.92  ±  3.45), diaphragm excursion during deep breaths (-0.82  ±  0.74 vs -0.38  ±  0.29), and diaphragm thickness fraction (-8.77  ±  3.22 vs -4.88  ±  2.69) compared with control group.


CONCLUSION
The combination of aerobic training, resistance training, and external diaphragm pacing obtained significant improvements in physical activity, respiratory function, body composition, arterial oxygen pressure, and diaphragm function in patients with chronic obstructive pulmonary disease.


TRIAL REGISTRATION
ChiCTR1800020257, www.chictr.org.cn/index.aspx.

Efficacy of aerobic training and resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease: A randomized controlled study.

Purpose Pulmonary rehabilitation (PR) is essential to manage patients with COPD. The aim of this study was to investigate the appropriate intensity of PR exercise training for patients with moderate-to-severe COPD. Patients and methods A prospective multicenter randomized controlled trial was conducted from January 2014 to October 2018. The subjects were randomly assigned to three groups with different intensities of PR, according to their maximum oxygen uptake percentage determined by cardiopulmonary exercise testing. After 20 weeks of exercise training, the effects of low-, moderate-, and high-intensity exercise interventions on patients were compared to determine the most appropriate PR prescription. Results For patients with moderate COPD, all the measured parameters were significantly improved in the moderate- and high-intensity PR groups (P 0.05). Conclusion High-intensity PR exercise is helpful for patients with moderate to severe COPD. Moderate COPD patients need to receive intensive PR training; the improvement degrees from PR intervention were higher than those of the severe COPD patients. For patients with severe COPD, high-intensity PR exercise may be more beneficial if patients can tolerate it.

https://www.dovepress.com/getfile.php?fileID=53184

Benefits of different intensities of pulmonary rehabilitation for patients with moderate-to-severe COPD according to the GOLD stage: a prospective, multicenter, single-blinded, randomized, controlled trial.

Background: Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular disease (CVD), which is attributed to chronic intermittent hypoxia (CIH) induced inflammation. As a new inflammatory biomarker of CVD, monocyte to high-density lipoprotein cholesterol ratio (MHR) has received little attention in OSA studies to date. Therefore, we aimed to investigate the correlation between MHR and concomitant CVD in Chinese Han patients with OSA.
 Methods: A total of 657 Chinese Han subjects (169 controls, 145 mild, 94 moderate, and 249 severe OSA) of both genders were enrolled in this cross-sectional study, with an average BMI of 32.35±6.56 kg/m 2 . The relationship between MHR and concomitant CVD in OSA patients was analyzed.
 Results: The level of MHR was correlated positively with apnea-hypopnea index (AHI), while negatively with lowest SpO 2 (P vs . 12.73±5.06, P Conclusions: MHR is strongly correlated with the severity of OSA and the occurrence of CVD in OSA patients. As an easy and available test, MHR is expected to be a promising biomarker candidate in predicting CVD in Chinese Han patients with OSA.

/pdf/relationship-between-monocyte-to-hdl-cholesterol-ratio-and-2p4miye9od.pdf

Relationship between monocyte to HDL cholesterol ratio and concomitant cardiovascular disease in Chinese Han patients with obstructive sleep apnea.

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Benefits of different intensities of pulmonary rehabilitation for patients with moderate-to-severe COPD according to the GOLD stage: a prospective, multicenter, single-blinded, randomized, controlled trial.

Relationship between monocyte to HDL cholesterol ratio and concomitant cardiovascular disease in Chinese Han patients with obstructive sleep apnea.