As demonstrated, heart rate variability (HRV) biofeedback (HRVB) is effective in managing chronic conditions. However, reviews specifically addressing HRVB effects on cardiac autonomic dysfunction in patients with cardiovascular diseases (CVDs) are lacking. We evaluated HRVB effects on autonomic, hemodynamic, and psychological outcomes in such patients. This systematic review and meta-analysis of randomized controlled trials (RCTs) searched MEDLINE, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi from inception to April 2025. We included RCTs on HRVB in CVD populations and excluded those without HRV, clinical, or psychological outcomes. Two reviewers independently screened, extracted data, and assessed risk of bias using Cochrane RoB 2 tool. Random-effects models were applied to HRV indices, blood pressure, respiratory rate, and psychological outcomes. From 2402 records, 13 RCTs (965 participants; 795 analyzed) were included. HRVB significantly improved the standard deviation of NN interval; low-frequency (LF) and logLF increased, high-frequency (HF) and logHF showed no significant changes. Both systolic (mean difference [MD] = − 3.08, 95
Patients with cancer of unknown primary origin (CUP) account for 2-5% of all types of cancer worldwide and have a poor prognosis, with a reported 1-year survival rate of ~20%. Furthermore, global data indicate that in patients with unfavorable subsets, the median overall survival (OS) is ~12 months from the initiation of first-line therapy; however, reliable prognostic biomarkers in patients with the unfavorable subset are yet to be elucidated. As nutritional indices are used as prognostic factors in various malignancies, such as gastrointestinal cancer, the present retrospective study aimed to examine the impact of nutritional status on the prognosis of patients that underwent chemotherapy for CUP. The association between four indices of nutritional status and OS and progression-free survival (PFS) was investigated in 25 patients with CUP who received chemotherapy at Kurume University Hospital (Kurume, Japan) between July 2011 and June 2023. Nutritional status was evaluated using the prognostic nutritional index, neutrophil-to-lymphocyte ratio (NLR), modified Glasgow prognostic score (mGPS) and controlling nutritional status (CONUT) score. Low NLR (≤3), mGPS (0-1) and CONUT (0-3) scores indicated good nutritional status. The median PFS and OS for all patients were 6.3 and 17.2 months, respectively. Univariate analyses revealed that low mGPS [hazard ratio (HR), 0.27; 95% confidence interval (CI), 0.09-0.80; P=0.017) and CONUT (HR, 0.23; 95% CI, 0.07-0.75; P=0.015) scores were favorable prognostic factors for OS. Furthermore, a low mGPS (HR, 0.21; 95% CI, 0.08-0.61; P=0.004) score was predictive of favorable PFS. Multivariate analyses revealed that low mGPS (HR, 0.21; 95% CI, 0.05-0.94; P=0.041) and CONUT (HR, 0.20; 95% CI, 0.05-0.90; P=0.035) scores, and a low mGPS (HR, 0.20; 95% CI, 0.06-0.71; P=0.012) score, were independent prognostic factors for OS and PFS, respectively. In conclusion, a good nutritional status (as indicated by low mGPS and CONUT scores) independently predicted a potentially favorable prognosis in chemotherapy-treated patients with CUP. These results may be used in order to estimate prognosis before chemotherapy.
Atherosclerotic cardiovascular disease (ACVD) is increasingly recognized as a chronic inflammatory disorder involving complex interactions across vascular, metabolic, immune, and neurobiological systems. Conventional imaging modalities primarily assess anatomical features of atherosclerosis but provide limited insight into underlying inflammatory activity. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) enables noninvasive, quantitative assessment of metabolic activity associated with inflammation in vivo. Beyond vascular plaques, FDG-PET/CT can simultaneously evaluate inflammatory processes in adipose tissue, hematopoietic organs, and stress-related neural circuits, offering a systems-level perspective of disease pathophysiology. Accumulating evidence demonstrates that increased FDG uptake in these tissues is associated with cardiovascular risk, plaque instability, and adverse clinical outcomes. Moreover, FDG-PET/CT has emerged as a valuable tool for monitoring therapeutic responses, providing insights into the anti-inflammatory effects of pharmacological interventions. This review summarizes current evidence on the role of FDG-PET/CT in assessing multi-organ inflammatory processes in ACVD and highlights its potential to improve risk stratification and guide personalized therapeutic strategies through a systems-level imaging framework.
PURPOSE:Our objective was to evaluate the utilization and clinical impact of CONNECT-LR, an asynchronous teleconsultation system for locally recurrent rectal cancer (LRRC), focusing on resectability assessment and clinical trial referral. METHODS:In this multicenter, prospective observational study, we included all cases submitted to CONNECT-LR between August 2019 and March 2025, as well as referring physicians and consultants. Referring physicians securely uploaded anonymized clinical and imaging data through a dedicated platform, and consultants responded within 1 week. Data were collected in predefined categories, including consultation purposes and recommendations, physician and institutional characteristics, and user and consultant surveys assessing satisfaction and clinical course. The analysis comprised descriptive statistics. RESULTS:Overall, 77 consultations were conducted. Most referring physicians were gastrointestinal surgeons (97.4%). The primary purpose of consultation was resectability assessment in 55 cases (71.4%). Of the 34 cases initially judged as unresectable or with uncertain resectability by referring physicians, 24 (70.6%) were reclassified as resectable by consultants, and surgical resection was performed in 15 of these 34 cases (44.1%), predominantly following referral to consultants' institutions. Six patients were enrolled in a randomized controlled trial for resectable LRRC. User satisfaction was high: 93.3% of referring physicians and 76.1% of consultants reported being satisfied or somewhat satisfied. CONCLUSIONS:CONNECT-LR effectively provides expert judgment, often altering resectability assessments and increasing access to curative-intent surgery for patients with LRRC, offering a potential pathway to clinical trial participation. As a feasible, secure, and scalable model, this teleconsultation platform may help reduce regional disparities and expand access to subspecialty care for LRRC.
