Although further protocol optimization is needed to improve overground translation of treadmill gains, a definitive RCT comparing HIT and MCT appears to be feasible and warranted.

Patients with cancer have been identified in several studies to be at high risk of developing severe COVID-19; however, rates of SARS-CoV-2 IgG seroconversion and its association with cancer types and anticancer therapy remain obscure. We conducted a retrospective cohort study in patients with cancer who underwent SARS-CoV-2 IgG testing. Two hundred and sixty-one patients with a cancer diagnosis underwent SARS-CoV-2 IgG testing and demonstrated a high rate of seroconversion (92%). However, significantly lower seroconversion was observed in patients with hematological malignancies (82%), patients who received anti-CD-20 antibody therapy (59%) and stem cell transplant (60%). Notably, all 17 patients who received immunotherapy, including 16 that received anti-PD-1/PD-L1 monoclonal antibodies, developed SARS-CoV-2 IgG antibodies (100% seroconversion). These data show differential rates of seroconversion in specific patient groups and bear importance for clinical monitoring and vaccination strategies that are being developed to mitigate the COVID-19 pandemic.

Aim: To assess safety via electrocardiographic (ECG), blood pressure (BP), heart rate (HR), and orthopedic responses to 3 different HIIT protocols in persons with stroke.Methods: 18 participants (10 male; 61.9 + 8.3 yo; 5.8+ 4.2 y post stroke) completed a symptomlimited stress test (GXT) with ECG monitoring to screen for eligibility and determine HR peak. Results:No signs or symptoms of CV intolerance, significant arrhythmias, ST segment changes or orthopedic responses resulted in early termination of any HIIT session. HIIT elicited HR's in excess of 88% of measured HR peak including 6 (P30), 8 (P60) and 2 (P120) participants eliciting a HR response above their GXT HR peak . Both, maximum BP and HR were significantly higher in P30 and P60 relative to P120. Conclusion:Preliminary data indicate that persons with chronic stroke who have been prescreened with an ECG stress test, a symptom-limited GXT, and a harness for fall protection; may safely participate in HIIT generating substantially higher HR's than what is seen in traditional moderate intensity training.

Derived regression equations, 80% HRpeak and 62% HRRpeak, provide a specific target intensity for initial aerobic exercise prescription that should minimize underdosing and overdosing for persons with chronic stroke. The specificity of these methods may lead to more efficient and effective treatment for poststroke deconditioning.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A114).

Patients with cancer have been identified in several studies to be at high risk of developing severe COVID-19; however, rates of SARS-CoV-2 IgG seroconversion and its association with cancer types and anti-cancer therapy remain obscure. We conducted a retrospective cohort study in patients with cancer that underwent SARS-CoV-2 IgG testing. Two hundred and sixty-one cancer patients underwent SARS-CoV-2 IgG testing and demonstrated a high rate of seroconversion (92%). However, significantly lower seroconversion was observed in patients with hematologic malignancies (82%), patients that received anti-CD-20 antibody therapy (59%), CAR-T/cellular therapy (33%) and stem cell transplant (60%). Interestingly, all 17 patients that received immunotherapy, including 16 that received anti-PD-1/PD-L1 monoclonal antibodies, developed SARS-Cov-2 IgG antibodies (100% seroconversion). These data show differential rates of seroconversion in specific patient groups and bear importance for clinical monitoring and vaccination strategies that are being developed to mitigate the COVID-19 pandemic

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INTRODUCTION: “Flood syndrome,” also known as spontaneous umbilical hernia rupture, is a rare complication of end-stage liver disease and persistent ascites. We present a case of a patient who developed Flood syndrome prompting emergent surgical management. CASE DESCRIPTION/METHODS: A 63-year-old man with cryptogenic cirrhosis and ascites presented with worsening diffuse abdominal pain. Physical exam revealed a massively distended abdomen with generalized tenderness and a large umbilical hernia (UH) with ulceration of the overlying skin. Abdominal CT scan revealed large, loculated, abdominopelvic ascites with a large ventral hernia containing ascites (Figure 1). Despite undergoing two large-volume therapeutic paracentesis, he experienced spontaneous rupture of an ulcerated UH while attempting to defecate during this hospitalization. Likely greater than 10 L of ascitic fluid poured out leading to hypotension and prompt emergent exploratory laparotomy with repair of the defect in the abdominal wall. DISCUSSION: UH is seen in up to 20% of patients with cirrhosis and persistent ascites [1]. It is the result of the chronically weakened state of the abdominal wall surrounding the umbilicus in the setting of increased intra-abdominal pressure. Flood syndrome can occur when the tense pressure of ascites leads to spontaneous rupture of an umbilical hernia site with drainage of a large volume of ascitic fluid. It is a serious condition, with a mortality of over 60%. Rupture of an umbilical hernia site in Flood syndrome can be provoked by vomiting, coughing, or straining with defecation. In Flood syndrome, treatment begins with fluid resuscitation and antibiotics to prevent infection. Once stable, emergent surgical repair of the abdominal wall defect is essential. Non-surgical management is not advised and is associated with higher mortality. To prevent complications and improve mortality, these patients should be treated immediately with surgical intervention [2].

Introduction: Aerobic deconditioning is a major barrier to stroke recovery. Post stroke guidelines recommend moderate intensity continuous exercise (MICE) to improve aerobic fitness and mobility. High-intensity interval training (HIT) has been shown to be more effective than MICE for improving aerobic fitness among healthy adults and persons with heart disease. However, no previous study has compared HIT and MICE among persons with stroke. We hypothesized that HIT would elicit significantly greater improvement in both aerobic fitness and gait function relative to MICE in this population. Methods: Fourteen subjects (mean ± SD age, 58 ± 10 years; years post stroke, 4.3 ± 2.9) were randomized to HIT (n=11) or MICE (n=5); each 25 min, 3x/week for 4 weeks. HIT involved repeated 30 sec bursts of treadmill (TM) gait at maximum tolerated speed (based on gait stability), alternated with 30-60 sec rest periods. MICE involved continuous TM gait at 45-50% heart rate reserve. Outcomes were measured by a blinded rater before and after intervention, including peak oxygen uptake and ventilatory threshold during graded exercise testing, energy cost of gait, 10m walk test (comfortable and fastest speeds) and TM speed (comfortable and fastest). Mixed effects models tested for significant (p<0.05) differences over time within groups and between the groups. Standardized effect sizes were also calculated. Results: In the HIT group, significant improvement was found for all outcomes save peak oxygen uptake. No significant differences were found in the MICE group. Ventilatory threshold and fastest TM speed improved significantly more in HIT compared to MICE and moderate to large effect sizes were found for all outcomes. Conclusion: HIT is a potent intervention for improving aerobic fitness and gait function in chronic stroke that appears to be more effective than MICE. Further study with a larger sample is warranted.