Treatment related morbidity in breast cancer patients

Background: Sentinel lymph node biopsy (SLNB) was introduced for staging of the axilla to reduce the number of unnecessary axillary lymph node dissections (ALND’s) and proved to be an accurate and safe procedure to predict metastatic disease in clinically negative axillary lymph nodes. SLNB was expected to have less treatment related morbidity in comparison to ALND. In a multicenter prospective cohort study, long term upper-limb morbidity, perceived disabilities in activities of daily life (ADL) and quality of life (QOL) were assessed before and six weeks, 12 month and 24 month after SLNB or ALND for breast cancer. - \ud Methods: 204 patients with stage I/II breast cancer, mean age 55.6 years (sd: 11.6) entered the study and 181 patients (89%) could be evaluated after two years. Sixty-six patients (32%) underwent SLNB only, and 138 (68%) underwent a level I-II ALND. Reliable and valid assessment instruments were used for assessment of upper limb morbidity, ADL and QOL. Assessment included evaluation of shoulder range of motion, muscle strength, grip strength, pain, upper/forearm circumference, shoulder disability and activities of daily life (ADL) and Quality of Live. - \ud Results: Considerable treatment related upper-limb morbidity was observed. Significant (p<0.05) changes between before and up till two years after surgery were found in almost all assessments of shoulder function, ADL and several QOL subscales. Patients in the ALND group showed significant more changes in range of motion (ROM), grip strength, arm volume, ADL and QOL physical- and role functioning, pain and sleeplessness and arm symptoms compared to the SLNB group. Upper limb morbidity and associated disabilities in ADL are at worse in the early stage (first months) after surgical treatment. Concerning arm edema; in the ALND group arm volume increased significantly at 1 and 2 years follow up. Concerning QOL, significantly differences in mean change over the two years comparing SLNB with ALND were found for physical and role functioning and also for symptom items such as pain, insomnia (sleeplessness) and arm symptoms in favor of the SLNB group. QOL in the SLNB group was just improving in the 2 years after treatment whereas in de ALND group only emotional functioning and future perspective improved. Multivariate linear regression analysis showed that radiation therapy on the axilla is besides ALND an important factor in the prediction of impaired shoulder ROM and arm edema. Radiation therapy on the breast had no influence on shoulder ROM. - \ud Conclusion: 1. Significant treatment related short-term, middle-term and long-term upper limb morbidity and perceived disabilities in ADL and long-term reduction of QOL exist in breast cancer patients. 2. In the assessment of changes in upper limb function, ADL and QOL, ALND is the most frequent found predictor of deterioration. Additional radiation therapy on the axilla predicts a further decrease in shoulder ROM and arm edema. 3. Long-term upper limb morbidity is significantly correlated with disabilities in ADL and worsening of QOL

Use and usability of custom-made orthopedic shoes

The goal of this study was to investigate the use of custom-made orthopedic shoes (OS) and the association between the use of OS and the most relevant aspects of their usability. Over a 6-month period, patients meeting the inclusion criteria were recruited by 12 orthopedic shoe companies scattered throughout the Netherlands and asked to complete a questionnaire composed of a pre- and post-OS section. Patients with different pathologies were included in the study (n = 339; response 67%). Mean age of the patients was 63 +/- 15 years, and 38% were male. Three months after delivery, 81% of the patients used their OS frequently (4-7 days/week), 13% occasionally (1-3 days/week), and 6% did not use their OS. Associations were found between use and all measured aspects of usability (p-values varied from <0.001 to 0.028). Patients who used their OS more often had a more positive opinion regarding all the aspects of usability. We conclude that all aspects of the usability of OS are relevant in relation to their use and should be taken into account when prescribing and evaluating OS

Lower limb amputation - Part 2:Rehabilitation - a 10 year literature review

Ten years after the ISPO consensus conference on amputation surgery, a search of relevant publications in the Rehabilitation-prosthetics-literature over the years 1990-2000 was performed. The main key-words in this research were: "lower limb, amputation, human and rehabilitation". One hundred and four (104) articles were assessed by reading and from these the authors selected 24 articles. These articles are summarised, under several subheadings in this review article, focussing especially on quality of Life, functional outcome and predictive factors.</p

Dialogue Act Recognition via CRF-Attentive Structured Network

Dialogue Act Recognition (DAR) is a challenging problem in dialogue interpretation, which aims to attach semantic labels to utterances and characterize the speaker's intention. Currently, many existing approaches formulate the DAR problem ranging from multi-classification to structured prediction, which suffer from handcrafted feature extensions and attentive contextual structural dependencies. In this paper, we consider the problem of DAR from the viewpoint of extending richer Conditional Random Field (CRF) structural dependencies without abandoning end-to-end training. We incorporate hierarchical semantic inference with memory mechanism on the utterance modeling. We then extend structured attention network to the linear-chain conditional random field layer which takes into account both contextual utterances and corresponding dialogue acts. The extensive experiments on two major benchmark datasets Switchboard Dialogue Act (SWDA) and Meeting Recorder Dialogue Act (MRDA) datasets show that our method achieves better performance than other state-of-the-art solutions to the problem. It is a remarkable fact that our method is nearly close to the human annotator's performance on SWDA within 2% gap.Comment: 10 pages, 4figure