Treatment-induced neuroendocrine prostate cancer and de novo neuroendocrine prostate cancer:Identification,prognosis and survival,genetic and epigenetic factors

Neuroendocrine prostate cancer(NEPC)shows an aggressive behavior compared to prostate cancer(PCa),also known as prostate adenocarcinoma.Scanty foci in PCa can harbor genetic alternation that can arise in a heterogeneity of prostate cancer.NEPC may arise de novo or develop following androgen deprivation therapy(ADT).NEPC that arise following ADT has the nomenclature“treatmentemerging/induced NEPC(t-NEPC)”.t-NEPC would be anticipated in castration resistant prostate cancer(CRPC)and metastatic PCa.t-NEPC is characterized by low or absent androgen receptor(AR)expression,independence of AR signaling,and gain of neuroendocrine phenotype.t-NEPC is an aggressive metastatic tumor,develops from PCa in response to drug induced ADT,and shows very short response to conventional therapy.t-NEPC occurs in 10%-17%of patients with CRPC.De novo NEPC is rare and is accounting for less than 2%of all PCa.The molecular mechanisms underlying the trans-differentiation from CRPC to t-NEPC are not fully elucidated.Sphingosine kinase 1 plays a significant role in t-NEPC development.Although neuroendocrine markers:Synaptophysin,chromogranin A,and insulinoma associated protein 1(INSM1)are expressed in t-NEPC,they are non-specific for diagnosis,prognosis,and follow-up of therapy.t-NEPC shows enriched genomic alteration in tumor protein P53(TP53)and retinoblastoma 1(RB1).There are evidences suggest that t-NEPC might develop through epigenetic evolution.There are genomic,epigenetic,and transcriptional alterations that are reported to be involved in development of t-NEPC.Knock-outs of TP53 and RB1 were found to contribute in development of t-NEPC.PCa is resistant to immunotherapy,and at present there are running trials to approach immunotherapy for PCa,CRPC,and t-NEPC.

Effects of relaxation breathing exercise on fatigue and cortisol level among Indonesian gynecological cancer patients undergoing chemotherapy:a pilot study

Objective:This study aimed to determine the effect of the relaxation breathing exercise(RBE)on fatigue and cortisol levels among Indonesian women with gynecological cancer undergoing chemotherapy.Methods:This pilot study consecutively recruited 44 gynecological cancer patients to receive RBE(22)or usual care(22).Cortisol level was measured before and after completion of the intervention(day 8).Fatigue was measured using the Piper Fatigue Scale(PFS).Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale(HADS)at the baseline days of the study for days 1,4,and 8.The obtained data were analyzed using Fisher’s exact test,the independent t-test,and the Mann-Whitney U test.Results:There were significant increases in cortisol levels within the groups,either the intervention or control groups,respectively(P-value=0.0003 and 0.001).Despite there being no statistical significance between the intervention and control groups,there were noticeable differences in the cortisol levels,indicating the extreme increase in cortisol levels in the control group(Median[IQR1-IQR3]:2.30[0.99-9.09];Min-Max:0.43-23.38)compared with the intervention group(Median[IQR1-IQR3]=2.97[1.26-5.18];Min-Max=0.39-6.91).Conclusions:RBE helps prevent a significant increase in cortisol levels that can alleviate fatigue for women with gynecological cancer.Further research was recommended to compare several intervention modalities for fatigue and cancer-related symptom management based on cortisol level changes.

Jianpi Fuzheng Decoction in the Treatment of Gastric Cancer-Related Fatigue

Objective:To observe the clinical effects of Jianpi Fuzheng Decoction in patients with gastric cancer and cancer-related fatigue(CRF).Methods:Using the random number table method as a reference,68 cases of gastric CRF were randomly divided into two groups.One group served as the control group and received basic treatment,while the other was the observation group.The observation group,in addition to the control group’s treatment,received Jianpi Fuzheng Decoction.The clinical treatment effectiveness,fatigue scores,immune function indicators,and treatment safety were compared between the two groups.Results:The total clinical treatment effectiveness of the observation group and the improvement in immune function indicators after treatment were higher than those of the control group.The fatigue score after treatment was lower in the observation group than in the control group(P<0.05).No serious adverse reactions occurred during the treatment in either group.Conclusion:Jianpi Fuzheng Decoction can enhance the clinical treatment effectiveness for gastric cancer patients with CRF.It facilitates the acceleration of fatigue symptom improvement and immune function enhancement.The medication’s safety is guaranteed,making it worthy of promotion.

Mechanism of cancer-induced fatigue

Cancer related fatigue(CRF)is one of the most common and painful reactions in cancer patients.Due to the negative effects of cancer itself and long-term treatment,patients often feel continuous burnout,fatigue and powerlessness in both mental and physical aspects.Fatigue related to cancer and cancer treatment will affect the physical and mental health of cancer patients for a long time and continuously,and it is hard to be relieved through rest.Nowadays,most of the researches focus on the clinical manifestations of patients with cancer,such as pain,nausea and vomiting,weight loss and so on.The fatigue feeling of cancer patients is often one of the most easily overlooked pain symptoms in the treatment process.The influence of CRF on cancer patients may be one of the reasons for reducing the survival time of cancer patients.This paper aims to summarize and explore the pathogenesis of cancer-related fatigue,in order to analyze the related factors of cancer-related fatigue from multi-dimensional and multi-angle,and provide reference for its comprehensive treatment in clinic.

Associations of self-reported and device-assessed physical activity with fatigue,quality of life,and sleep quality in adults living with and beyond cancer

Background Greater physical activity is associated with improved outcomes in people living with and beyond cancer.However,most studies in exercise oncology use self-reported measures of physical activity.Few have explored agreement between self-reported and device-based measures of physical activity in people living with and beyond cancer.This study aimed to describe physical activity in adults affected by cancer across self-reported and device-assessed activity,to explore levels of agreement between these measures in terms of their utility for categorizing participants as meeting/not meeting physical activity guidelines,and to explore whether meeting guidelines is associated with fatigue,quality of life,and sleep quality.Methods A total of 1348 adults living with and beyond cancer from the Advancing Survivorship Cancer Outcomes Trial completed a survey assessing fatigue,quality of life,sleep quality,and physical activity.The Godin-Shephard Leisure-Time Physical Activity Questionnaire was used to calculate a Leisure Score Index(LSI)and an estimate of moderate-to-vigorous physical activity(MVPA).Average daily steps and weekly aerobic steps were derived from pedometers worn by participants.Results The percentage of individuals meeting physical activity guidelines was 44.3%using LSI,49.5%using MVPA,10.8%using average daily steps,and 28.5%using weekly aerobic steps.Agreement(Cohen'sκ)between self-reported and pedometer measures ranged from 0.13(LSI vs.average daily steps)to 0.60(LSI vs.MVPA).After adjusting for sociodemographic and health-related covariates,meeting activity guidelines using all measures was associated with not experiencing severe fatigue(odds ratios(ORs):1.43–1.97).Meeting guidelines using MVPA was associated with no quality-of-life issues(OR=1.53).Meeting guidelines using both self-reported measures were associated with good sleep quality(ORs:1.33–1.40).Conclusion Less than half of all adults affected by cancer are meeting physical activity guidelines,regardless of measure.Meeting guidelines is associated with lower fatigue across all measures.Associations with quality of life and sleep differ depending on measure.Future research should consider the impact of physical activity measure on findings,and where possible,use multiple measures.

Energy efficiency training's effect on fatigue scores of children with a cancer diagnosis

Objective:Fatigue is the most common complication of cancer treatment procedure during chemotherapy,leading to limited daily activities,mood swings,and ultimately impaired functional status.This study aimed to determine the effect of energy efficiency training on the fatigue scores of children with a cancer diagnosis.Methods:In the present clinical trial study,30 children with a cancer diagnosis were randomly assigned variously to the control and testing groups.The cancer-related fatigue questionnaire for children with cancer was employed as the data collection tool.The intervention of the testing group was conducted in 4 sessions of 45-60 min of face-to-face interaction,group sessions,and questionand-answer sessions.Meanwhile,routine interventions were employed in the control group.Quantitative variables were repor ted as mean and standard deviation,and qualitative variables as frequency and percentage.Stata 11 statistical software and a change score approach were used to analyze the data.Results:The mean fatigue score of the testing group increased from 72.12 to 77.53.There was a statistically significant difference between the mean fatigue scores of the testing group before and after the intervention(P=0.013),and the children’s fatigue score decreased.There was a statistically significant difference between the mean fatigue scores of the testing and control groups before and after the intervention(P=0.001),and the fatigue score of the children in the testing group had decreased compared to the control group.Conclusions:Energy efficiency techniques can be employed to increase energy and reduce fatigue during pediatric chemotherapy.

Adenosine triphosphate induced cell death: Mechanisms and implications in cancer biology and therapy

Adenosine triphosphate(ATP)induced cell death(AICD)is a critical cellular process that has garnered substantial scientific interest for its profound relevance to cancer biology and to therapeutic interventions.This comprehensive review unveils the intricate web of AICD mechanisms and their intricate connections with cancer biology.This review offers a comprehensive framework for comprehending the multifaceted role of AICD in the context of cancer.This is achieved by elucidating the dynamic interplay between systemic and cellular ATP homeostasis,deciphering the intricate mechanisms governing AICD,elucidating its intricate involvement in cancer signaling pathways,and scrutinizing validated key genes.Moreover,the exploration of AICD as a potential avenue for cancer treatment underscores its essential role in shaping the future landscape of cancer therapeutics.

Fatigue Life Assessment of Top Tensioned Risers Under Vortex-Induced Vibrations

The fatigue life of top tensioned risers under vortex-induced vibrations (VIVs) with consideration of the effect of internal flowing fluid on the riser is analyzed in the time domain.The long-term stress histories of the riser under VIVs are calculated and the mean stresses,the number of stress cycles and amplitudes are determined by the rainflow counting method.The Palmgren-Miner rule for cumulative damage theory with a specified S-N curve is used to estimate the fatigue life of the riser.The corresponding numerical programs numerical simulation of vortex-induced vibrations (NSVIV) which can be used to calculate the VIV response and fatigue life of the riser are compiled.Finally the influences of the riser's parameters such as flexural rigidity,top tension and internal flow velocity on the fatigue life of the riser are analyzed in detail and some conclusions are drawn.

Effects of Internal Flow on Vortex-Induced Vibration and Fatigue Life of Submarine Pipelines

With the rapid development of the offshore oil industries, submarine oil / gas pipelines have been widely used. Under the complicated submarine environmental conditions, the dynamic characteristics of pipelines show some new features due to the existence of both internal and external flows. The paper is intended to investigate the vortex-induced vibration of the suspended pipeline span exposed to submarine steady flow. Especially, the effects of the flow inside the pipeline are taken into account. Its influences on the amplitude of pipeline response, and then on the fatigue life, are given in terms of the velocity of the internal flow.

Induced pluripotent stem cells as suitable sensors for fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome

BACKGROUND Fibromyalgia(FM)and myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)are devastating metabolic neuroimmune diseases that are difficult to diagnose because of the presence of numerous symptoms and a lack of specific biomarkers.Despite patient heterogeneity linked to patient subgroups and variation in disease severity,anomalies are found in the blood and plasma of these patients when compared with healthy control groups.The seeming specificity of these“plasma factors”,as recently reported by Ron Davis and his group at Stanford University,CA,United States,and observations by our group,have led to the proposal that induced pluripotent stem cells(iPSCs)may be used as metabolic sensors for FM and ME/CFS,a hypothesis that is the basis for this indepth review.AIM To identify metabolic signatures in FM and/or ME/CFS supporting the existence of disease-associated plasma factors to be sensed by iPSCs.METHODS A PRISMA(Preferred Reported Items for Systematic Reviews and Meta-analysis)-based systematic review of the literature was used to select original studies evaluating the metabolite profiles of FM and ME/CFS body fluids.The MeSH terms“metabolomic”or“metabolites”in combination with FM and ME/CFS disease terms were screened against the PubMed database.Only original studies applying omics technologies,published in English,were included.The data obtained were tabulated according to the disease and type of body fluid analyzed.Coincidences across studies were searched and P-values reported by the original studies were gathered to document significant differences found in the disease groups.RESULTS Eighteen previous studies show that some metabolites are commonly altered in ME/CFS and FM body fluids.In vitro cell-based assays have the potential to be developed as screening platforms,providing evidence for the existence of factors in patient body fluids capable of altering morphology,differentiation state and/or growth patterns.Moreover,they can be further developed using approaches aimed at blocking or reversing the effects of specific plasma/serum factors seen in patients.The documented high sensitivity and effective responses of iPSCs to environmental cues suggests that these pluripotent cells could form robust,reproducible reporter systems of metabolic diseases,including ME/CFS and FM.Furthermore,culturing iPSCs,or their mesenchymal stem cell counterparts,in patient-conditioned medium may provide valuable information to predict individual outcomes to stem-cell therapy in the context of precision medicine studies.CONCLUSION This opinion review explains our hypothesis that iPSCs could be developed as a screening platform to provide evidence of a metabolic imbalance in FM and ME/CFS.

Real-time surface electromyography in Parkinson's disease patients during exercise-induced muscle fatigue

To explore the mechanisms underlying exercise-induced local muscle fatigue in patients with idiopathic Parkinson＇s disease （PD）,we used surface electromyography to record myoelectric signals from the tibialis anterior muscle during isometric contraction-induced fatigue until exhaustion.The results revealed no significant differences between patients with idiopathic PD and healthy controls in maximum voluntary contraction of the tibialis anterior muscle.The basic characteristics of surface electromyography were also similar between the two groups.The duration of isometric contraction at 50% maximum voluntary contraction was shortened in PD patients.In addition,PD patients exhibited a stronger increase in mean square amplitude,but a weaker decrease in median frequency and mean power frequency compared with healthy controls during isometric contraction.The skeletal muscles of PD patients revealed specificity of surface electromyography findings,indicating increased fatigability compared with healthy controls.

Effects of Exercise on Cancer-related Fatigue and Quality of Life in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Meta-analysis of Randomized Clinical Trials

Objective To gain insight on how exercise affects the outcomes of prostate cancer patients treated with androgen deprivation therapy,specifically cancer-related fatigue(CRF) and quality of life(QoL). Methods Systematic searches for randomized clinical trials(RCTs) evaluating the effects of exercise on CRF and QoL of prostate cancer patients receiving androgen deprivation therapy were carried out to identify the eligible studies from EMBASE,Pub Med and Cochrane library. Related data were extracted from eligible studies and then subjected to Reviewer Manage 5.3 for analysis. Standardized mean differences(SMD) and its 95% confidence interval(CI) were calculated. Results In all,10 RCTs involving 841 prostate cancer patients(448 of whom exercised and 393 did not) were included in this study. With respect to CRF,there was good consistency among different studies,and it was remarkably reduced in the exercise group(SMD=-0.32,95% CI:-0.45 to-0.18,P<0.00001,n=784). In regards to QoL,there was also good consistency among different studies,and it was also improved significantly in the exercise group(SMD=0.21,95% CI:0.08 to 0.34,P=0.002,n=841). Conclusion Exercise both reduced CRF and improved QoL in prostate cancer patients receiving androgen deprivation therapy.

Long-term fatigue state in postoperative patients with breast cancer

Objective：To investigate the prevalence of long-term fatigue,anxiety,depression and social support,and the relationships among these symptoms in postoperative patients with breast cancer.Methods：A total of 180 postoperative patients with breast cancer meeting criterion were recruited in this cross-sectional study.The Brief Fatigue Inventory （BFI）,Hospital Anxiety and Depression Scale （HADS） and The Social Support Survey-Chinese version were used to assessing the fatigue,anxiety and depression,Social support of participants.The magnitude of the relationship among the symptoms of fatigue and other variables was measured by Spearman Rho correlation.Results：The prevalence of long-term fatigue was 52.7％,and 18.3％ occurred moderate/severe fatigue.Two-thirds of patients had a basal social support,only 12.8％ of patients had better-perceived social support.Results of HADS showed that 16.7％ and 21.1 ％ of the participants have anxiety or depression disorder.Moderate/severe fatigue was negatively correlated with social support （r=-0.158,P=0.038） and positively correlated with age （r=0.132,P=0.042）,chemotherapy （r=0.297,P=0.027）,anxiety （r=0.324,P=0.018） and depression （r=0.211,P=0.034）.Conclusions：Long-term fatigue was highly prevalent among over half of postoperative patients with breast cancer,and moderate/severe fatigue was associated with social and psychological factors such as social support,anxiety and depression.Our results suggest that overall nursing care may be a more effective manner in improving fatigue and quality of life.

Vision-based fatigue crack detection using global motion compensation and video feature tracking

Fatigue cracks that develop in civil infrastructure such as steel bridges due to repetitive loads pose a major threat to structural integrity.Despite being the most common practice for fatigue crack detection,human visual inspection is known to be labor intensive,time-consuming,and prone to error.In this study,a computer vision-based fatigue crack detection approach using a short video recorded under live loads by a moving consumer-grade camera is presented.The method detects fatigue crack by tracking surface motion and identifies the differential motion pattern caused by opening and closing of the fatigue crack.However,the global motion introduced by a moving camera in the recorded video is typically far greater than the actual motion associated with fatigue crack opening/closing,leading to false detection results.To overcome the challenge,global motion compensation(GMC)techniques are introduced to compensate for camera-induced movement.In particular,hierarchical model-based motion estimation is adopted for 2D videos with simple geometry and a new method is developed by extending the bundled camera paths approach for 3D videos with complex geometry.The proposed methodology is validated using two laboratory test setups for both in-plane and out-of-plane fatigue cracks.The results confirm the importance of motion compensation for both 2D and 3D videos and demonstrate the effectiveness of the proposed GMC methods as well as the subsequent crack detection algorithm.

Protein induced by vitamin K absence or antagonist Ⅱ-producing gastric cancer

Protein induced by vitamin K absence or antagonist Ⅱ(PIVKA-Ⅱ) is a putative specific marker of hepatocellular carcinoma(HCC),but it may also be produced by asmall number of gastric cancers.To date,16 cases of PIVKA-Ⅱ-producing gastric cancer have been reported,2 of which were reported by us and all of which were identified in Japan.There are no symptoms specific to PIVKA-Ⅱ-producing gastric cancer,and the representative clinical symptoms are general fatigue,appetite loss,and upper abdominal pain.Serum alpha-feto-protein(AFP)levels are also increased in almost allcases.Liver metastasis is observed in approximately 80% of cases and portal vein tumor thrombus is ob-served in approximately 20% of cases.Differential diagnosis between metastatic liver tumor and HCC is often difficult.Grossly,almost all cases appear as advanced gastric cancer.Histologically,a hepatoid pattern is observed in many cases,in addition to a moderately to poorly differentiated adenocarcinoma component.The production of PIVKA-Ⅱ and AFP is usually confirmed using immunohistochemical staining.Treatment and prognosis largely depends on the existence of liver meta-stasis,and the prognosis of patients with liver metas-tasis is very poor.PIVKA-Ⅱ may be produced during the hepatocellular metaplasia of the tumor cells.

Establishment and identification of induced pluripotent stem cells in liver cancer patients

Objective:To induce pluripotent stem(IPS)cells from fibrocytes that are separated from liver cancer patients.Methods:The fibrocytes were reprogrammed to IPS cells by lentiviral vector,stained and identified by immunohistochemistry.Results:The IPS cells were successfully established from fibrocytes after infection,and IPS cell clones formed in round shape under a microscopy.The induction rate was 0.013%±0.007%.No tumor formed at the back of nude mice within 8 weeks after the inoculation of cell clone.However,tetatoma appeared in nude mice within 1 week after IPS inoculation.A few tumors formed in nude mice within 4 weeks after the inoculation of cell clones.However,subcutaneous tumors formed within 1 week after IPS inoculation.The induced IPS cells showed three germ layers in tetatoma.Nanog and OCT4 in the induced IPS cells showed hypomethylation.SSEA-A,TRA-1-6-,TRA-1-81 and Nanog were highly expressed in the induced IPS cells,indicating the IPS cells possessed the similar ability as the stem cells.Conclusion:The IPS cells of liver cancer patients can be established effectively from fibrocytes and can be cultured stably in vitro,which provides an approach for the treatment of intermediate or advanced stage liver cancer.

Fatigue prevalence in men treated for prostate cancer:A systematic review and meta-analysis

BACKGROUND The side effects of prostate cancer(PCa)treatment are very prominent,with cancer-related fatigue(CRF)being the most common.Fatigue is a distressing symptom that interferes with daily functioning and seriously affects patient quality of life during,and for many years after,treatment.However,compared with other types of cancer,such as breast cancer,little is known about the prevalence of PCa-related fatigue.AIM To determine the prevalence of CRF in patients with PCa.METHODS A systematic search of EMBASE,PubMed,Web of Science,Cochrane Library,Chinese National Knowledge Infrastructure,WANFANG DATA,Technology Journal Database and the Chinese Biological Medical Database was conducted up to July 28,2020.Included studies measured the incidence of PCa-related fatigue and differentiated fatigue outcomes(incidence)between treatment modalities and fatigue assessment times.In our meta-analysis,both fixed and random-effects models were used to estimate the pooled prevalence of PCa-related fatigue.Subgroup analyses were performed using treatment modalities and fatigue assessment times.Publication and sensitivity bias analyses were performed to test the robustness of the associations.RESULTS Fourteen studies,involving 4736 patients,were eligible for the review.The pooled CRF prevalence was 40%in a total sample of 4736 PCa patients[95%confidence interval(CI):29-52;P<0.01;I2=98%].The results of the subgroup analyses showed the prevalence of CRF after androgen deprivation therapy treatment,radical prostatectomy and radiotherapy to be 42%(95%CI:20-67,P<0.01,I2=91%),21%(95%CI:16-26,P=0.87,I2=0%)and 40%(95%CI:22-58,P<0.01,I2=90%),respectively.The prevalence of acute and persistent fatigue was 44%(95%CI:25-64;P<0.01;I2=93%)and 29%(95%CI:25-32;P=0.30;I2=17%),respectively.CONCLUSION Our meta-analysis showed that fatigue is a common symptom in men with PCa,especially those using hormone therapy.

ESTABLISHMENT OF DIFFERENTIAL DISPLAY mRNA AND ITS APPLICATION IN THE STUDY ON THE MECHANISM OF LUNG CANCER INDUCED BY RADIATION

Objective: A method for separating mRNAs by means of the polymerase chain reaction (differential display mRNA), and identifying the genes related to radiation-induced lung cancer was introduced. Methods: The RNAs were isolated from two pairs of samples, SV40-immortalized human fetal tracheal fibroblast cell (SHTF) versus αSHTF cell (transformed SHTF cell induced by α particles) and lung cancer tissue versus normal lung tissue obtained from one miner, and amplified by RTPCR. The differential expressed gene fragments were displayed by autoradiograph or silver nitrate stain. Results: The differential display mRNA method was established using both cell and tissue samples. The bands stained by silver nitrate were clearer than those on X-ray film. The rate of reamplification of differentially expressed gene fragments stained by silver nitrate is 80%, higher than that by autoradiograph, 50%. Conclusion: Differential display mRNA method was established successfully on both cell and tissue samples. The modified method for staining band increased the rate of reamplification and established the basis for confirming relative genes.

An isolate alpha-fetoprotein producing gastric cancer liver metastasis emerged in a patient previously affected by radiation induced liver disease

We report a case of an isolated hepatic neoplasia which originated in a site of the liver previously affected by radiation induced liver disease (RILD) in a patient resected for gastric cancer and referred to us for high serum alpha-fetoprotein (AFP) levels. This case challenged us in distiguishing, even histologically, between primary liver cancer and AFP producing gastric cancer metastasis. Only a panel of immunohis-tochemical markers allowed the definitive diagnosis of liver metastasis of endodermal stem cell-derived and AFP producing gastric cancer. We discuss the criteria for a differential diagnosis, as well as the possible link between RILD and emergence of liver neoplasia.

Effectiveness of Relaxation Breathing Exercise on fatigue in gynecological cancer patients undergoing chemotherapy

Purpose:This study aimed to determine the effectiveness of Relaxation Breathing Exercise(RBE)on fatigue in patients with gynaecological cancer undergoing chemotherapy.Methods:We used a quasi-experiment with pre-and post-test design.Forty-two patients were consecutively sampled,21 of whom were assigned to the group receiving RBE four times a day and 21 to the group receiving RBE twice a day.Fatigue scores were measured every day for 7 days for both groups using the Piper Fatigue Scale.Data obtained were analysed using repeated-ANOVA and independent ttest with a significant level of a<0.01.Results:We found a significant decrease(P<0.01)in the mean fatigue scores of both groups(four times RBE in a day group=3.29±0.59 and twice RBE in a day group=4.19±0.61)after the completion of the intervention.However,the four times RBE a day group showed larger decrease on fatigue scores than the twice RBE a day group did(Mean Difference=0.91;99%CI=0.41 to 1.41;P=0.001).Conclusion:Conducting RBE four times a day effectively alleviated fatigue better than RBE twice a day on gynaecological cancer patients undergoing chemotherapy.