Early alterations in cancer include the deregulation of epigenetic events such as changes in DNA methylation and abnormal levels of non-coding (nc)RNAs. Although these changes can be identified in tumors, alternative sources of samples may offer advantages over tissue biopsies. Because tumors shed DNA, RNA, and proteins, biological fluids containing these molecules can accurately reflect alterations found in cancer cells, not only coming from the primary tumor, but also from metastasis and from the tumor microenvironment (TME). Depending on the type of cancer, biological fluids encompass blood, urine, cerebrospinal fluid, and saliva, among others. Such samples are named with the general term “liquid biopsy” (LB). With the advent of ultrasensitive technologies during the last decade, the identification of actionable genetic alterations (i.e., mutations) in LB is a common practice to decide whether or not targeted therapy should be applied. Likewise, the analysis of global or specific epigenetic alterations may also be important as biomarkers for diagnosis, prognosis, and even for cancer drug response. Several commercial kits that assess the DNA promoter methylation of single genes or gene sets are available, with some of them being tested as biomarkers for diagnosis in clinical trials. From the tumors with highest incidence, we can stress the relevance of DNA methylation changes in the following genes found in LB: SHOX2 (for lung cancer); RASSF1A, RARB2, and GSTP1 (for lung, breast, genitourinary and colon cancers); and SEPT9 (for colon cancer). Moreover, multi-cancer high-throughput methylation-based tests are now commercially available. Increased levels of the microRNA miR21 and several miRNA- and long ncRNA-signatures can also be indicative biomarkers in LB. Therefore, epigenetic biomarkers are attractive and may have a clinical value in cancer. Nonetheless, validation, standardization, and demonstration of an added value over the common clinical practice are issues needed to be addressed in the transfer of this knowledge from “bench to bedside”.

Background: Exercise-based cardiac rehabilitation (EBCR) plays a pivotal role in the management of acute myocardial infarction (AMI). Studies have shown that older individuals have a worse prognosis after an AMI, attesting to the importance of risk reduction strategies. We aimed at assessing the impact of age (patients dichotomized as ≥65 years old or <65 years old) on the functional benefits of an EBCR program among AMI survivors. Design: Observational, retrospective cohort study. Participants: All patients admitted due to an AMI who completed a phase II EBCR program after discharge, between November 2012 and April 2017. Intervention: EBCR program. Measurements: Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. Results: A total of 379 patients were included (30% aged ≥65 years). After the EBCR program, peak oxygen uptake (pVO2) and exercise duration increased significantly. Patients aged ≥65 years presented with more comorbidities and a lower functional capacity. Those aged ≥65 years presented significantly smaller improvements in pVO2 (0.79 ± 2.61 vs. 1.60 ± 3.11 mL/kg/min, p = 0.016) and exercise duration [75 (59–120) vs. 120 s (60–180), p = 0.002]. This was maintained after adjusting for several potential confounders. Conclusion: Older patients have a worse functional capacity than their younger counterparts. Still, a contemporary EBCR program was associated with significant functional improvements among those aged ≥65 years. The smaller improvements even after adjustments for potential confounders suggest that physiological differences may contribute to this finding. These results highlight the relevance of EBCR among this higher-risk subgroup.

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Introduction Exercise-based cardiac rehabilitation (EBCR) is part of the management of patients who have suffered an acute myocardial infarction (AMI). Patients with a reduced ejection fraction (EF) comprise a higher-risk subgroup and are referred less often for these programmes. This study aimed at assessing the impact of the baseline EF on the functional benefits, as assessed by peak oxygen uptake (pVO 2 ) and exercise duration, of an EBCR programme in AMI survivors. Methods Observational, retrospective cohort study including all patients admitted to a tertiary centre due to an AMI who completed a phase II EBCR programme after discharge, between November 2012 and April 2017. Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. Results A total of 379 patients were included [40.9% with reduced EF (<50%) at discharge]. After the programme, pVO 2 and exercise duration increased significantly ( p < 0.001). Patients with a reduced EF had a lower pVO 2 and completed a shorter duration of exercise at the beginning and end of the programme. This group presented a higher increase in pVO 2 ( p = 0.001) and exercise duration ( p = 0.007). This was maintained after adjusting for age, gender, history of coronary artery disease, number of sessions, Killip classification, arterial hypertension, dyslipidaemia, diabetes mellitus, smoking status and baseline pVO 2 . Conclusion A phase II EBCR programme was associated with significant improvements in pVO 2 and exercise duration among AMI survivors, irrespective of baseline EF classification. Those with a reduced baseline EF derived an even greater improvement, highlighting the importance of EBCR in this subgroup of patients.

Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

Objetivo: Evaluar las percepciones de la enfermedad que se asocian con hábitos de vida saludable en pacientes con enfermedades crónicas en Medellín y municipios aledaños. Método: Estudio prospectivo correlacional basado en la aplicación del cuestionario breve de percepciones de la enfermedad (BIPQ), cuestionario de la salud del paciente (PHQ-9), cuestionario de ansiedad generalizada (GAD-7) y un cuestionario de hábitos de vida saludable. Participaron 51 pacientes con diferentes enfermedades crónicas: migraña, cáncer de seno, diabetes, artritis reumatoide, enfermedad cardiovascular e hipertensión arterial primaria. La evaluación de los hábitos de vida saludable se llevó a cabo tres meses después. Resultados: Se encontró que en promedio los participantes comprenden su enfermedad (M = 8,09, D.T. =2,48), perciben que sus acciones (M = 7,06, D.T. = 2,79) y el tratamiento (M = 7,89, D.T. = 2,69) la controlan y que esta tiene un carácter crónico (M = 7,49, D.T. = 3,16); que hay correlaciones entre los Hábitos de vida saludables (HVS) con la percepción de consecuencias de forma negativa, y la identidad y preocupación emocional de manera positiva (p < 0,05). Además, que una relación lineal entre las consecuencias (Beta= 0,391) y la preocupación emocional por la enfermedad (Beta = 0,311) con los HVS, F (5, 45) = 2,707, p < 0,05. Las proporciones de depresión y ansiedad en la muestra fueron similares a las de la población general. Conclusiones: La percepción de que una enfermedad tiene consecuencias negativas y la preocupación por esta lleva a la implementación de comportamientos saludables.

Suberosis is an occupational lung disorder of cork industry workers usually presenting as an extrinsic allergic alveolitis, but airway involvement in some cases makes the diagnostic approach complex. We assessed peak expiratory flow rates (PEF) in 17 cork workers with asthma symptoms that worsened at work, comparing three methods of PEF graph analysis. Complete agreement (three observers) was found in 12 of 17 cases (70.6%) with the visual inspection of mean daily values and in 11 of 17 cases (64.7%) with the minimum, maximum, and mean daily values (without any consensus in two cases). According to the mean PEF graph, there were eight positive readings (47%), five negative readings (29%), and four dubious readings (24%); with the other graphic analysis, two of the dubious cases were reclassified as negative. When we analyzed daily variability >20%, we found only three positive results, one of which was in absolute disagreement with the visual analysis. Our results suggest that it is possible to demonstrate occupational asthma in cork work exposure. The visual inspection of PEF monitoring shows a greater number of positive results than the index of daily variability; however, the latter may help to sort out dubious cases.