and emotional well-being, lymphedema management, and maintenance of BMD in BCS. Large randomized controlled trials are necessary to determine whether exercise can reduce the risk of cancer recurrence in BCS. Participation in regular exercise, preferably both AE and RE modes, can alleviate some cancer treatment-related side effects and improve survivorship. Although the scientific knowledge supporting participation in exercise is profound, exercise adherence remains a challenge in BCS. In future, health care-supported exercise programs for cancer survivors may be necessary, similar to cardiac rehabilitation exercise programs for cardiac patients, to promote a behavioral change to a more active lifestyle.
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A research area gaining strength is the relationship between cancer and fatigue, and how exercise influences fatigue. In a meta-analysis, Stricker, Drake, Hoyer, and Mock (2004) stated that cancer-related fatigue is the most common and distressing side effect of cancer treatment, and that fatigue has a profound effect on daily living. They also stated that exercise is effective in combating cancer-related fatigue and that this belief is strongly supported in research. Effect sizes were moderate to large in the analysis, and consistently showed that exercise can reduce symptoms of cancer-related fatigue. Researchers believed patients should be encouraged to maintain physical activity during and following cancer treatments, because “exercise has been shown to be the most effective non-pharmacological intervention for cancer-related fatigue” (Stricker et al., 2004, p. 963). More research is needed to come up with more concrete evidence-based guidelines for exercise prescriptions for cancer patients.
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Anti-cancer treatment results in decreased muscle mass, accumulation of abdominal fat tissue, and reduction of aerobic capacity and joint operating range, while sarcopenia increases physical dysfunction, 17 duration of hospitalization, 18 rates of hospital-acquired infection, 19 and chemotherapy-related toxicities. 20 Muscle mass itself is even proposed as an impor- tant indicator for reduced toxic side effects of chemotherapy, 21 and muscle mass evaluation is recommended to be quanti ﬁ ed by computed tomography images as done in the current study. 22 In this study, unlike the control group, there were no signi ﬁ cant reductions in MFR in the exercise group, indicating that the muscle mass had been kept constant through exercise while undergoing adjuvant treatment for about 6 months. Compared to a previous study, 14 which even showed increased muscle mass by exercise during the treatment period, the results of this study may be disappointing; however given that the study patients were comparatively old, it seemed obvious that the exercise program had been effective.
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The standard treatment pathway for magnetic resonance (MR)-defined, locally advanced rectal cancer is neoadju- vant chemoradiotherapy (CRT) followed by total mesor- ectal excision surgery [1, 2]. Chemotherapy, combined with radiotherapy, improves local disease control and local recurrence for locally advanced rectal cancer [3–5]. With optimised local treatment, including neoadjuvant CRT and surgery, local relapse rates have now been re- duced to less than 10 % . Cancer is associated with cachexia, which, in the pre-operative period, has been shown to influence perioperative outcome, increasing the risk of complications, mortality and length of hos- pital stay in major gastrointestinal surgery . Chemo- therapy has been related to skeletal muscle wasting, oxidative stress, mitochondrial death  and reduced in vivo mitochondrial function . Furthermore, cancer treatment has been linked to decreased physical fitness levels, which appear to be related to the type of treatment; that is, physical fitness is lower in those receiving surgery and radiotherapy in combination with chemotherapy than in those who receive radiotherapy or surgery alone . Neoadjuvant CRT has been shown to be associated with a decrease in objectively measured physical fitness, as mea- sured by cardiopulmonary exercise testing (CPET) in those with locally advanced rectal cancer . This de- crease in physical fitness was in turn shown to be associ- ated with increased short-term post-operative morbidity . Moreover, a decrease in physical fitness has also been shown in a group of upper gastrointestinal cancer patients following neoadjuvant chemotherapy . In this case, the change was associated with 1-year mortality .
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MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exer cises, previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading. CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide ap propriate patient education and referral.
other oncolytic virus like reovirus and herpes virus exhibit that cyclophosphamide decrease the innate immune responses, extend viral gene expression and proliferation, and improve oncolytic effect. Alternate mechanisms to target cancer cells is to distinctively erase off the undesirable tropism. This is achieved by specifically constructing the virus for various specified target organs in their genomes to facilitate the selective blocking of the virus’s life cycle in the target organs like brain, liver , muscle specific micro RNA. Another method is to alter the viruses so as to produce immune –stimulating chemicals.
ABPM over 5 hours (light: –7.7 ± 2.4 mmHg and moder- ate: –9.4 ± 2.8 mmHg), compared to controls; however, only light-intensity exercise reduced diastolic ABPM (–5.7 ± 2.2 mmHg). Systolic and diastolic ABPM were also lowered, with light-intensity exercise, over 10 hours during daytime (–3.8 ± 1.3 and –4.0 ± 1.3 mmHg, respectively) and nighttime (–6.0 ± 2.4 and –6.1 ± 1.6 mmHg, respectively), and diastolic ABPM over 19 hours (–4.8 ± 1.2 mmHg). The authors found that both light- and moderate-intensity aerobic exercise elicit transient reductions in ambulatory blood pressure of patients with resistant hypertension. However, light intensity seems to sustain longer effects. 45 These results are contrary to other
6MWT walked distance of 632 meters in healthy subjects in Bogota which is higher to the median of the EIH and non-EIH distance walked in this study. It is interesting that both groups walked the same distance and had no difference in dyspnea scales before and after the 6MWT; this was evidenced in the study by Adrianopoulos but in no other studies. 18,22 It should be mentioned that dyspnea and exercise capacity in COPD patients is related to multiple factors: diminished ventilator capacity, increased ventilator demand and inspiratory effort, dynamic hyperin ﬂ ation, hypercapnia, hypoxia, cardiovascu- lar factors, and psychological factors. 20,21 Therefore, related factors could be explaining those ﬁ ndings. No differences were found between the scores of the dyspnea scales in both groups, nor were differences in FEV1, FVC, or FEV1/FVC ratio between the two groups. Although FVC is not related to the development of EIH, FEV1 remains inconclusive. 18,23,24 The present study also reveals that SaO 2 is not a good
People with type 1 diabetes who begin an exercise regimen should tailor their exercise regimen to their specific condition. For instance, a patient with peripheral neuropathy must take precau- tions to avoid blisters and abrasions and check closely for such conditions after exercising. Patients should consider delaying exercise if their blood glucose is > 250 mg/dl and ketones are present or if their blood glucose level is > 300 mg/dl. They should monitor blood glucose before and after physical activity and be cautious about hypoglycemia, which can develop during or even several hours after exercise. They should have carbohydrate sources available and consume them as necessary to avoid hypoglycemia. Although studies have not demonstrated a clear benefit of aerobic exercise on A1C levels in type 1 diabetes, aerobic exercise is clearly beneficial in controlling other risk fac- tors for cardiovascular disease. 32
The shift in treatment paradigms to move docetaxel earlier in the care pathway comprises of both positive effects and a degree of uncertainty when fitness for treatment is considered. On one hand, men receiving docetaxel at hormone sensitive stages will likely be on average younger and have a better PS when compared to the castrate resistant setting. The combination of doce- taxel with ADT at hormone sensitive stages has also been shown to significantly increase progression free survival meaning these men enter the castrate resistant phase of the disease later . These men are therefore, at this stage, not only likely to tolerate the docetaxel better, maintaining the optimum drug dosage, but pro- long the time to which they will need further therapy for advancing disease. On the other hand, when men do eventually progress to CRPC, the long term effects of a previous docetaxel regimen on PS and fitness for treat- ment are unclear. This may also be compounded by the
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exercise regimen is therefore of the utmost importance and crucial to successful treatment; lack of adherence being recognised as a major barrier to symptom improvement (Bø & Talseth, 1996; Chen et al., 1999). Reasons for PFME non- adherence may be varied but could be due to women having low PFME self- efficacy. Self-efficacy is the belief in one’s ability to make or pursue a specific action or change (Bandura, 1986) and is influenced by social, personal and situational factors. It is known to be an important construct in behaviour change and, in this context, is the belief that a woman can perform PFME correctly and often enough to be effective in improving her urinary incontinence. Clinician- supported conservative treatment would be expected to increase self-efficacy, and less clinician supervision appears to compromise self-efficacy in women with SUI (Kim, 2001; Demain et al., 2006). This is of concern, as continence service reviews increasingly scrutinise the cost-effectiveness of the contact time, and number of follow-up sessions, offered to patients. As biofeedback is thought to improve motivation, it is proposed that the addition of sEMG biofeedback may function by increasing self-efficacy to perform PFME, enhancing the value of clinical contact time available to women.
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Adjuvant intravesical immunotherapy with Bacil- lus Calmette-Guerin (BCG) is recommended for patients with carcinoma in situ (CIS) and high- grade Ta or T1 bladder cancer (22, 23, 26). Irani- an guidelines recommend a 6-wk induction course of Bacillus Calmette–Guerin (BCG) in multifocal or recurrent low-grade Ta, high-grade Ta, T1 and CIS bladder tumors. In addition, maintenance intravesical therapy with BCG is recommended for high-grade Ta, T1 and CIS bladder tumors (24). The cost of a 6-wk induc- tion course of full-dose BCG in Iran is about US$347 and US$672 in the public and private sectors, respectively. Intravesical immunotherapy with BCG is a cost-effective treatment and the cost per year of life saved was lower than US$5000 (27-29). The frequency of use of in- travesical chemotherapy and immunotherapy in NMIBC has not been reported in Iran.
role of PR in patients with lung cancer after lung re- section. However, these trials were initially designed to compare different primary endpoints due to different foci; moreover, clinically important endpoints, such as exercise capacity and QoL, have not been adequately investigated due to limited data in each trial. Results of these trials are inconclusive because of the wide variation in sample sizes employed. Thus far, the effect of exercise training on patients with lung cancer after lung resection remains controversial. In the present study, we performed a meta-analysis on available RCTs to investigate the role of exercise training in adult pa- tients following lung cancer surgery.
results were encouraging because we found high levels of CD44sol in most patients with laryngeal carcinoma with high specificity compared with controls, and the highest levels of CD44sol were observed in patients with advanced stages of disease. Our and Franzmann et al’s results are promising because of their high diagnostic power, and sug- gest that CD44sol could be a specific diagnostic marker of head and neck cancer. 52,55–57
A foreign investor should not expect the same level of internet security from every state in which it operates, as security against cyber crimes can be expensive and require a high level of technical proficiency and human resources. 93 This is the embodiment of the Panchekniki dicta: ‘an unpredictable instance of civil disorder…which overwhelms the limited capacity of [a state] which is poor and vulnerable.’ 94 The elaboration of ‘due diligence’ under the FPS standard as offered by AAP hints that investors should have a lower expectation in Developing States: ‘[due diligence means] reasonable measures of prevention which a well-administered government could be expected to exercise under similar circumstances.’ 95 While a reasonable level of administration can be expected, this must be balanced against the context in which the events have occurred. Sornarajah writes that this will include the intensity of the strife and the resources that could be diverted for the purposes of protection. 96 In addition to intensity, possibly meaning the number of individuals harmed, this balancing should include the nature of the civil disturbance. States with lower internet connectivity will inevitably have a diminished capacity to address highly technical disturbances such as cyber attacks.
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representative of the general human population living with T1DM 36,70 . The disparity between blood glucose levels typically observed in humans with T1DM and those reported in rodent models of diabetic myopathy is an important consideration as hyperglycemia per se has been shown to have deleterious effects on skeletal muscle. Krause et al. have indicated that some of the negative outcomes of hyperglycemia related to the diabetic myopathic condition and negative regulation of muscle mass likely includes the formation of advanced glycation end products (AGE), chronic oxidative stress, and the polyol pathway 11 . Hypoinsulinemia per se is also a key contributor alongside hyperglycemia to diabetic myopathy. Humans and animals with T1DM that are not subjected to insulin treatment develop a catabolic state where the rate of protein catabolism exceeds the rate of protein synthesis, and in turn results in a net loss of protein that is especially evident in skeletal muscle 75 . Hence, the use of intensive and conventional insulin therapy treatment for sedentary and exercised diabetic animals in the present study was also likely a significant contributor to the maintenance of body and whole-muscle weight as well as fiber CSA that was observed in all groups. The effects of insulin treatment on skeletal muscle mass in T1DM have been determined to be due primarily to an anti-catabolic effect in the reduction of muscle protein breakdown as opposed to an increase in muscle protein synthesis
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must be done’. In this context, the option of not receiving cancer treatment may sit uncomfortably. However, the way in which the alternative to cancer treatment is understood and presented must be considered. In the UK and many other countries, ‘best supportive care’ is the term used to describe the plan when people are too unwell for, or choose not to have, cancer treatment. Whilst this sounds like a management plan that might offer something meaningful and helpful, our experience is that this is often not the case, for the most part because there is no agreement about what it means in practice. 22 We suggest that unless we can describe
Methods: We conducted a descriptive study to quantify the functions of a clinical pharmacist in HCV treatment of patients living with HIV/HCV coinfection who were initiating HCV treatment at a publicly funded clinic between March 18, 2015 and September 15, 2016. The clinical phar- macist’s role was categorized into eight categories: 1) HCV prior authorization (PA) completion; 2) HCV medication adherence counseling; 3) HCV drug-drug interaction (DDI) counseling and screening; 4) HCV medication counseling regarding common adverse events (AEs); 5) HCV counseling regarding HCV treatment outcomes and risk of reinfection; 6) ordering laboratory tests and interpretation of HCV laboratory values; 7) HIV medication AE assessment; and 8) other (including refilling medications and management of other comorbidities).
A question arises as to what happens if S is time-dependent and how a material behaves under this kind of operation. The phenomenon of fatigue failure occurs and if the part is loaded by a static load its lifetime is longer than the lifetime of the part loaded by dynamic load. Stress-life definitions have been introduced whereby several regions could be distinguished such as low-cycle-fatigue -region, high-cycle-fatigue-region, finite-life-re gion, infinite-life-region. These S-N definitions describe the p art’s lifetime in accordance to sine -wave loads with variable amplitudes.
Abstract: Cancer is a generic term that encompasses a group of diseases characterized by an uncontrolled proliferation of cells. There are over 200 different types of cancer, each of which gains its nomenclature according to the type of tissue the cell originates in. Many patients who succumb to cancer do not die as a result of the primary tumor, but because of the systemic effects of metastases on other regions away from the original site. One of the aims of cancer therapy is to prevent the metastatic process as early as possible. There are currently many therapies in clinical use, and recent advances in biotechnology lend credence to the potential of nanotechnol- ogy in the fight against cancer. Nanomaterials such as carbon nanotubes (CNTs), quantum dots, and dendrimers have unique properties that can be exploited for diagnostic purposes, thermal ablation, and drug delivery in cancer. CNTs are tubular materials with nanometer-sized diameters and axial symmetry, giving them unique properties that can be exploited in the diagnosis and treatment of cancer. In addition, CNTs have the potential to deliver drugs directly to targeted cells and tissues. Alongside the rapid advances in the development of nanotechnology-based materials, elucidating the toxicity of nanoparticles is also imperative. Hence, in this review, we seek to explore the biomedical applications of CNTs, with particular emphasis on their use as therapeutic platforms in oncology.
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