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EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy

Introduction Radical cystectomy (RC) is the standard treatment for patients with non-metastatic muscle-invasive bladder cancer, as well as for patients with therapy refractory high-risk non-muscle invasive bladder cancer. However, 50–65% of patients undergoing RC experience perioperative complications. The risk, severity and impact of these complications is associated with a patient’s preoperative cardiorespiratory fitness, nutritional and smoking status and presence of anxiety and depression. There is emerging evidence supporting multimodal prehabilitation as a strategy to reduce the risk of complications and improve functional recovery after major cancer surgery. However, for bladder cancer the evidence is still limited. The aim of this study is to investigate the superiority of a multimodal prehabilitation programme versus standard-of-care in terms of reducing perioperative complications in patients with bladder cancer undergoing RC.Methods and analysis This multicentre, open label, prospective, randomised controlled trial, will include 154 patients with bladder cancer undergoing RC. Patients are recruited from eight hospitals in The Netherlands and will be randomly (1:1) allocated to the intervention group receiving a structured multimodal prehabilitation programme of approximately 3–6 weeks, or to the control group receiving standard-of-care. The primary outcome is the proportion of patients who develop one or more grade ≥2 complications (according to the Clavien-Dindo classification) within 90 days of surgery. Secondary outcomes include cardiorespiratory fitness, length of hospital stay, health-related quality of life, tumour tissue biomarkers of hypoxia, immune cell infiltration and cost-effectiveness. Data collection will take place at baseline, before surgery and 4 and 12 weeks after surgery.Ethics and dissemination Ethical approval for this study was granted by the Medical Ethics Committee NedMec (Amsterdam, The Netherlands) under reference number 22–595/NL78792.031.22. Results of the study will be published in international peer-reviewed journals.Trial registration number NCT05480735.

The social visuality of distant suffering

Sail with the tide

AbstractHistorically, epidemics and plagues are repeatedly reported to have happened since the ancient civilizations (Egypt, Greece, Rome and imperial China). Most known examples of a devastating global pandemics in recent history are the ‘Black Death’ (14th century) and the global influenza (1918-1919), also known as ‘Spanish Flu’, that has killed nearly 50 million people in the world. Even thoughpandemics may vary in their dimensions, length (short vs. long), scope (local/regional, national, global) and severity of effects (minimal effects or maximal effects), they all represent distinct exogenous and endogenous shocks that have far reaching effects on population, health, economy and other societal domains.Currently, the Covid-19 pandemic has relentlessly spreaded around the world, leaving behind destructive marks on health, populations, economies and societies. The Covid-19 could spread quickly around the globe because of the current structure of the global economy, which is highly interconnected through sophisticated global transport networks. An important characteristic of a suchnetworked complex system is it vulnerability to unattended events of systemic risk such as the Covid-19 pandemic for example. These systemic risks cause substantial cascading effects, which lead to extreme outcomes that could permanently alter economic, environmental, and social systems.In this article, we first, present, discuss and analyze the potential impacts of the Covid-19 on global economy, trade and supply chains, by focusing on Europe and/or the Netherlands. Second, we examine the effects of the Covid-19 crisis on the shipping industry and on the hub ports and the policy measures that have been applied by different countries around the world.

The impact of bed rest on human skeletal muscle metabolism

Insulin sensitivity and metabolic flexibility decrease in response to bed rest, but the temporal and causal adaptations in human skeletal muscle metabolism are not fully defined. Here, we use an integrative approach to assess human skeletal muscle metabolism during bed rest and provide a multi-system analysis of how skeletal muscle and the circulatory system adapt to short- and long-term bed rest (German Clinical Trials: DRKS00015677). We uncover that intracellular glycogen accumulation after short-term bed rest accompanies a rapid reduction in systemic insulin sensitivity and less GLUT4 localization at the muscle cell membrane, preventing further intracellular glycogen deposition after long-term bed rest. We provide evidence of a temporal link between the accumulation of intracellular triglycerides, lipotoxic ceramides, and sphingomyelins and an altered skeletal muscle mitochondrial structure and function after long-term bed rest. An intracellular nutrient overload therefore represents a crucial determinant for rapid skeletal muscle insulin insensitivity and mitochondrial alterations after prolonged bed rest.

Exercise and Type 2 Diabetes

Proefschrift dat onder andere een tweejarig interventie-onderzoek beschrijft naar het effect van een bewegingsprogramma bij personen met type 2 diabetes.

GLUT-4 expression is not consistently higher in type 1 than type 2 fibres of rat and human vastus lateralis muscles: an immunohistochemical study.

Immunofluorescence microscopy in this study shows that GLUT-4 protein expression is fibre-type specific within a muscle. It is postulated that both fibre-type-dependent and fibre-type-independent factors affect GLUT-4 expression.