Associations between health-related fitness and patient-reported symptoms in newly diagnosed breast cancer patients

Background:Newly diagnosed breast cancer patients experience symptoms that may affect their quality of life,treatment outcomes,and survival.Preventing and managing breast cancer-related symptoms soon after diagnosis is essential.The purpose of this study was to investigate the associations between health-related fitness(HRF)and patient-reported symptoms in newly diagnosed breast cancer patients.Methods:This study utilized baseline data from the Alberta Moving Beyond Breast Cancer Cohort Study that were collected within 90 days of diagnosis.HRF measures included peak cardiopulmonary fitness(peak volume of oxygen consumption(VO_(2peak))),maximal muscular strength and endurance,flexibility,and body composition.Symptom measures included depression,sleep quality,and fatigue.Adjusted multivariable logistic regression was performed for analyses.Results:Of 1458 participants,51.5%reported poor sleep quality,26.5%reported significant fatigue,and 10.4%reported moderate depression.In multivariable-adjusted models,lower relative VO_(2peak)was independently associated with a greater likelihood of all symptom measures,including moderate depression(p<0.001),poor sleep quality(p=0.009),significant fatigue(p=0.008),any symptom(p<0.001),and multiple symptoms(p<0.001).VO_(2peak)demonstrated threshold associations with all symptom measures such that all 3 lower quartiles exhibited similar elevated risk compared to the highest quartile.The strength of the threshold associations varied by the symptom measure with odds ratios ranging from-1.5 for poor sleep quality to-3.0 for moderate depression and multiple symptoms.Moreover,lower relative upper body muscular endurance was also independently associated with fatigue in a dose-response manner(p=0.001),and higher body weight was independently associated with poor sleep quality in an inverted U pattern(p=0.021).Conclusion:Relative VO_(2peak)appears to be a critical HRF component associated with multiple patient-reported symptoms in newly diagnosed breast cancer patients.Other HRF parameters may also be important for specific symptoms.Exercise interventions targeting different HRF components may help newly diagnosed breast cancer patients manage specific symptoms and improve outcomes.

Confounding Effect in Clinical Research of Otolaryngology and Its Control

Confounding effect is a critical issue in clinical research of otolaryngology because it can distort the research's conclusion. In this review, we introduce the definition of confounding effect, the methods of verifying and controlling the effect. Confounding effect can be prevented by research's design, and adjusted by data analysis. Clinicians would be aware and cautious about confounding effect in their research. They would be able to set up a research's design in which appropriate methods have been applied to prevent this effect.They would know how to adjust confounding effect after data collection. It is important to remember that sometimes it is impossible to eliminate confounding effect completely, and statistical method is not a master key. Solid research knowledge and critical thinking of our brain are the most important in controlling confounding effect.

NEAR-INFRARED MONITORING OF THE LUMBAR ERECTOR SPINAE MUSCLE IN HEALTHY MEN AND WOMEN DURING STATIC AND DYNAMIC ENDURANCE WORK

Understanding muscle hemodynamics using near-infrared spectroscopy is increasingly evident in the recent spinal disorders-related literature.However,none of these human studies addressed the issue of physiological limits for the lumbar muscle within the same participants during various exercise modes.The purpose of this study is to evaluate physiological limits for the lumbar muscle during dynamic and static endurance tests.On three separate days,22 healthy men and women performed three endurance protocols(static prone trunk extension,arm cranking,and pushing
pulling)until volitional exhaustion.For each protocol,minimum and maximum oxygenation and blood volume responses from the right lumbar erector spinae were obtained using a continuous dual wavelength near-infrared spectroscopy(Micro-Runman,NIM Inc.,PA,USA).Statistical analysis showed that greatest reduction in oxygenation(minimum)were obtained during dynamic exercises:pushing
pulling(2.1 times)and arm cranking(2.03 times)versus static test (P<0:05).Physiological change(calculated as the difference between maximum during recovery and minimum at the point of volitional exhaustion)during static test was lower[(66-75%for oxygenation)and(34-46%for blood volume)]than dynamic exercises (P<0:05).Contrary to the theory that sufficient occlusion of bloodflow to the lumbar muscle is possible with static trunk extension,it was concluded that a dynamic protocol until volitional exhaustion might be a good alternative in establishing near-infrared spectroscopy-derived physiological limits to the lumbar muscle.Further research is essential to identify an optimal calibration procedure for establishing true hypoxic values for the human lumbar muscle.

Notes on the Landmark Development of CBR in China

Community-based rehabilitation has a history of 22 years in China.In spite of the preliminary achievement and experiences obtained by the pioneering and trial projects,it was not until the beginning of the new century that CBR in China experienced a landmark development.This is characterized by a number of favorable policy by the government for CBR;the mechanism facilitating primary health care with CBR,a new work-force system of CBR reorganized with better motivation and efficiency,99 demonstration projects of CBR bringing about benchmark promotion effect and the active involvement in CBR by social resources agents.

Correlation between current intensity and effective duration in the treatment of botulinus toxin for cerebral palsy by myoelectricity locating

BACKGROUND： Researches prove that the treatment of cerebral palsy by botulinus toxin （BTX-A） can improve effect and prolong effective duration. Current intensity is the important factor during injection. OBJECTIVE： To observe the changes of motor function and muscular intensity of children with spastic cerebral palsy after injecting BTX-A and analyze correlation between current intensity and effective duration. DESIGN： Cases control trial before and after nerves block SETTING： Capital University of Medical Sciences, China Rehabilitation Research Center PARTICIPANTS： From June 2002 to November 2004, 14 children with spastic cerebral palsy were treated by BTX-A block. All children were hospitalized in the Children Rehabilitation Department of China Rehabilitation Research Center. The children included 9 male and 5 female, and ranged from 4 to 13 years old, and average age was （6±2） years. Muscular tension ranged from grade 1 to grade 3. The diagnosis and the tape of cerebral palsy based on standard of the Fist Nationwide Cerebral Palsy Symposium, and all children were diagnosed with electroencephalogram （EEG）, CT and MRI, and permitted by their guardians. METHODS： （1） Locating and calculation： To locate block points by G6805-2A electro-therapeutic apparatus （Shanghai Huayi Electronic Instrument Plant） at the least stimulating current （continuous wave; impulse frequency; 2.667-83.333 Hz; current intensity： 0-6 mA; voltage： 6 V） to touch off muscles contraction. The current intensity of each point was recorded, and the average current intensity of each patient was calculated at the same time. （2） Dose of BTX-A： Basing upon the spastic degree and weight of patients, the dose was made certain： dose （IU）=（scores of Modified Ashworth Scale ＋2.5） xweight （kg）. The number of the block points was in all 4. The dose of injection ranged from 50 IU to 160 IU with the average of （73.6＋25.8） IU. The BTX-A was made by Lanzhou Institute of Biological Products, and each bottle contains 100 IU BTX-A. Muscular tension was evaluated by Modified Ashworth Scale. The scale ranged from grade 0 to grade 4, and the scores were from 0 to 4. The higher the scores were, the higher the muscular tension was. （3） Effect： Changes of muscular tension were evaluated by modified Ashworth Scale before and after block. Motor function was evaluated by Physician Rating Scale （PRS） before and after treatment. It contained Gait pattern, Hindfoot （ankle） position （stance-floor contact）, Hindfoot position （foot strike）, Knee position （degree of recurvation）, Crouch and Speed of gait. The scores ranged from 0 to 14. The higher the points were, the better the motor function was. （4） Effective duration： The duration was definited by the recovering of the Modified Ashworth Scale. （5） Statistic analysis： Firstly, the current intensity and the effect duration were analyzed by One-Sample Kolmogorov-Smirnov Test, the current intensity： Z= 0.456, P= 0.985, the effective duration： Z= 0.557, P= 0.915. Both data were normal distribution. Secondly, both data were analyzed by Linear Regression. The efficiency of the BTX-A block was analyzed by paired-samples t test. MAIN OUTCOME MEASURES： （1） Changes of motor function of muscular tension; （2） correlation between current intensity and effective duration. RESULTS： Fourteen children with spastic cerebral palsy were all involved in the final analysis. （1） Therapeutic effect： The average score of Ashworth scale after block was lower than that before block [（1.02±0.34） points vs. （2.12±0.48） points, t= 3.644, P〈 0.01]. The average score of RPS after block was higherthan that before block [（9.75±2.78） points vs. （6.16±0.58） points, t =13.222, P〈 0.01]. （2） Relation between the current intensity and the effective duration： The current intensity was （0.1857±0.0506） mA, and the effective duration was （26.36±4.48） weeks. The current intensity was negative correlation with effective duration （r = -0.775, P = 0.01 ）. CONCLUSION： （1） BTX-A occlusion can decrease muscular tension and improve motor function of lower limbs of children with spastic cerebral palsy. （2） The lower the current intensity is, the longer the effective duration is.

An Occupational Perspective of Occupational Therapy and the Medical Hegemony System in Malaysia—Exploration for Further Research

Occupational Therapy is critically underdeveloped in many developing countries in Asia. There are many internal and external barriers to the growth of the profession, including lack of willpower and lack of professional representation in the government. This article aims to communicate the postulations for its stagnation across developing countries in Asia. An analytical reflection and historical review of the barriers to the growth of occupational therapy in Malaysia was conducted. Leaders in the field who met the inclusion criteria, collaborated to shape the reconstructions using an occupational reconstruction approach. The reconstruction guided key critical reflections on the roots of daily experiences to relive the cooperative action to problem solve the issues encountered by the profession in Malaysia. Medical hegemony was found as the active suppressor of the health professions, and can be seen as being beyond reproach in the Asian’s medical model that created occupational injustices. These occupational injustices hinder the growth of Occupational Therapy, do not serve the patients, science or the overall healthcare system. Autocratic governance has a debilitating impact on health sciences and its workforce especially around badly oppressed Asian countries. A greater systematic approach is needed to examine the extent, effect, problem solve and remediate the magnitude of injustices over the last decade—to make way for an inclusive and affordable care system.

Data and subject heterogeneity and data sharing:keys to translational success in spinal cord injury research?

Spinal cord injury(SCI)is a highly devastating and com plex inj u ry with many seconda ry consequences.Finding a treatment for SCI has been a rollercoaster ride through exciting peaks and sobering valleys.As a matter of fact,there are still no robust and reliable clinical treatments to minimize or repair spinal cord damage.

Meta-Learning Multi-Scale Radiology Medical Image Super-Resolution

High-resolution medical images have important medical value,but are difficult to obtain directly.Limited by hardware equipment and patient’s physical condition,the resolution of directly acquired medical images is often not high.Therefore,many researchers have thought of using super-resolution algorithms for secondary processing to obtain high-resolution medical images.However,current super-resolution algorithms only work on a single scale,and multiple networks need to be trained when super-resolution images of different scales are needed.This definitely raises the cost of acquiring high-resolution medical images.Thus,we propose a multi-scale superresolution algorithm using meta-learning.The algorithm combines a metalearning approach with an enhanced depth of residual super-resolution network to design a meta-upscale module.The meta-upscale module utilizes the weight prediction property of meta-learning and is able to perform the super-resolution task of medical images at any scale.Meanwhile,we design a non-integer mapping relation for super-resolution,which allows the network to be trained under non-integer magnification requirements.Compared to the state-of-the-art single-image super-resolution algorithm on computed tomography images of the pelvic region.The meta-learning multiscale superresolution algorithm obtained a surpassing of about 2%at a smaller model volume.Testing on different parts proves the high generalizability of our algorithm.Multi-scale super-resolution algorithms using meta-learning can compensate for hardware device defects and reduce secondary harm to patients while obtaining high-resolution medical images.It can be of great use in imaging related fields.

Exercise intolerance in heart failure with preserved ejection fraction： more than a heart problem

Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.

Genetic Effects on Sensorineural Hearing Loss and Evidence-based Treatment for Sensorineural Hearing Loss

In this article,the mechanism of inheritance behind inherited hearing loss and genetic susceptibilityin noise-induced hearing loss are reviewed.Conventional treatments for sensorineural hearing loss(SNHL),i.e.hearing aid and cochlear implant,are effective for some cases,but not without limitations.For example,they provide little benefit for patients of profound SNHL or neural hearing loss,especially when the hearing loss is in poor dynamic range and with low frequency resolution.We emphasize the most recent evidence-based treatment in this field,which includes gene therapy and allotransplantation of stem cells.Their promising results have shown that they might be options of treatment for profound SNHL and neural hearing loss.Although some treatments are still at the experimental stage,it is helpful to be aware of the novel therapies and endeavour to explore the feasibility of their clinical application.

Repairing the injured spinal cord: sprouting versus regeneration. Is this a realistic match?

The article by Meves and Zheng （2014） is addressing a continu- ous shift in the field of spinal cord injury （SCI） research that has occurred over the last century. Before that, the spinal cord was viewed as ＂hard wired＂ and treatment considerations were based on observations that axons in the periphery were able to regenerate, but those in the central nervous system （CNS） were not （David and Aguayo, 1981）.

Methodology and cohort profile for the Hangzhou Lumbar Spine Study: a study focusing on back health in a Chinese population

Back pain is a worldwide health problem, adding a tremendous burden to modern societies. However, little information on back health is available in China, even though a quarter of the world＇s population is Chinese. To enhance knowledge in this area, we designed and initiated the Hangzhou Lumbar Spine Study, which is a cross-sectional study of a general sample of mainland Chinese with focusing on disc degeneration, Modic changes, endplate lesions, and back pain. The study consists of a structured questionnaire to measure back pain history and lifetime exposure to suspected risk factors, magnetic resonance imaging of the lumbar spine, bone mineral density study of the spine and hip, and DNA sample analysis. Here we briefly introduce the study methodology, report the test-retest reliability of the questionnaire, and describe the cohort profile to date. Since May 2014, 301 randomly selected subjects（male/female, 122/179; mean age, 51.0 years; range, 20–87 years） have been recruited. Tests-retests of the questionnaire, completed by 40 participants, revealed good reliability. To our knowledge, the Hangzhou Lumbar Spine Study is the first population-based epidemiological study conducted to characterize lumbar spinal phenotypes and back pain, their interaction, and their associations with lifetime environmental exposure, in mainland Chinese. Epidemiological information obtained from a reliable questionnaire, magnetic resonance（MR） imaging data, dual energy X-ray absorptiometry（DXA） measurements, and DNA analysis may serve as a valuable reference for future studies on back health, particularly for mainland Chinese.

Effectiveness of hand self-shiatsu to improve sleep following sport-related concussion in young athletes: a proof-of-concept study

Objective: The prevalence of sport-related concussion(SRC) is high and results in a number of serious health consequences. One area that has received minimal research is the relationship between SRC and sleep. The literature shows that sleep deficiency is a frequent negative consequence of SRC. At the same time, sleep deficiency delays recovery from SRC and contributes added risk of symptom recurrence.A 2014 study of chronic pain patients who learned to apply the complementary and alternative medicine intervention hand self-shiatsu(HSS) had promising, sleep-promoting results that warrant further investigation with other populations. This proof-of-concept study explored the feasibility of HSS as an intervention to promote sleep onset and continuity for young adults with SRC.Methods: This study employed a prospective case-series design, where participants act as their own controls. Baseline and follow-up data included standardized self-reported assessment tools and sleep actigraphy.Results: Seven athletes, aged between 18 and 25 years, participated in the study. Although statistically significant improvement in actigraphy sleep scores between baseline and follow-up was not achieved,metrics for sleep quality and daytime fatigue showed significant improvement.Conclusion: These findings support the hypothesis that HSS has the potential to improve sleep and reduce daytime fatigue in young postconcussion athletes. This pilot study provides guidance to refine research protocols and lays a foundation for further, large-sample, controlled studies.

Gut microbiota and differential genes-maintained homeostasis is key to maintaining health of individuals with Yang-deficiency constitution

OBJECTIVE:Yang-deficiency constitution(YADC)is a common unbalanced constitution that predisposes individuals to certain diseases.However,not all people with YADC manifest develop diseases.This calls for delineation of the underlying molecular mechanisms.Previous studies suggested that the gut microbiota and gene differential expression should be considered.METHODS:In the present study,we compared profiles of gut microbiota between four healthy YADC individuals and those of five healthy balanced constitution(BC)counterparts,based on 16 S r RNA gene sequence analysis.Furthermore,YADC relevant genes identified by comparing 62 healthy YADC and 58 healthy BC individuals in total to perform intersection analysis,functional clustering and pathway enrichment analyses.RESULTS:The levels of harmful gut microbiota(Prevotellaceae,LDA score>4.0,P=0.0141)and beneficial gut microbiota(Ruminococcaceae,LDA score>4.0,P=0.0025,Faecalibacterium,LDA score>4.0,P=0.0484)were both elevated in healthy YADC individuals.Also,we found that the specific metabolic pathway with 2,6-Dichloro-p-hydroquinone 1,2-Dioxygenase(Pcp A)as the core in gut microbiota and the glutathione transferase activity has been enriched by YADC relevant genes in healthy YADC individuals were both responsible for the detoxification of halogenated aromatic hydrocarbon substances.CONCLUSIONS:Both beneficial and harmful factors had been detected in healthy YADC individuals,functionally,they may have triggered homeostasis to maintain the health of individuals with YADC.The homeostasis may be maintained by beneficial and harmful factors from gut flora and genes.Future studies are expected to focus on halogenated aromatic hydrocarbons and their detoxification processes.

Hand self-Shiatsu for sleep problems in p ersons with chronic pain: a pilot study

OBJECTIVE： Difficulty falling asleep （sleep latency） and staying asleep （sleep maintenance） are common problems for persons living with pain. Research demonstrates that sleep problems are, in turn, related to exacerbation of chronic pain. There is a growing body of evidence for a range of pragmatic, non-pharmacological sleep interventions that can potentially be incorporated into pain management programs. This study looks at the outcome of teaching patients with musculoskeletal pain standardized pre-bedtime hand self-Shiatsu （HSS） to reduce sleep latency. METHODS： A case series design, with participants acting as their own controls, was selected to facilitate hypothesis generation for this novel, under-researched intervention. Sleep efficiency, latency and maintenance, sleep beliefs, pain intensity and basic participant demographics were collected at baseline with actigraphy and standardized self-report questionnaires. After one week of baseline data collection, the HSS intervention was taught to participants. Follow-up data were collected at 2 and 8 weeks post-intervention. RESULTS： Data collected at baseline and the two follow-up periods revealed no apparent changes in the objective actigraphy data. However a trend toward improved self-reported sleep latency （time to fall asleep） and sleep duration （time spent asleep） emerged. A number of participants reported they were more concerned with increasing their period of unbroken sleep as opposed to their total sleep time and it is possible that HSS may be useful to be applied during nighttime awakenings as well as before bed. None of the participants reported adverse effects of the intervention. CONCLUSION： These preliminary findings are promising and future studies exploring the mechanism of action and with stronger control of treatment fidelity are indicated.