RCT investigating the influence of walking and a naturopathic intervention on fatigue, psychologic and immunologic parameters of breast cancer survivors with cancer-related fatigue

HINTERGRUND: Ein Drittel der Brustkrebsüberlebenden leidet nach erfolgreicher Krebstherapie unter einer anhaltenden Form der „Tumorassoziierten Fatigue“ mit mentalen, kognitiven und affektiven Anteilen der Erschöpfung und Auswirkungen auf Lebensqualität und Funktionen – bei unklarer, vermutet multifaktorieller Ätiologie. Moderates Ausdauertraining und psychologisch-edukative Interventionen werden für diese anhaltende Erschöpfungsform empfohlen. Randomisierte Studien fehlen. Eine Pilotstudie hatte die Erschöpfung von Brustkrebspatientinnen durch eine 10-wöchige naturheilkundlich-tagesklinische Intervention signifikant bessern können. FRAGESTELLUNG: Die randomisierte zweiarmige Interventionsstudie sollte klären, ob eine multimodal-naturheilkundliche psychoedukative Intervention, kombiniert mit Ausdauertraining, die anhaltende Erschöpfung Brustkrebsüberlebender und ihre Parameter stärker bessern kann als ein alleiniges körperliches Training. MATERIAL&METHODEN: Von den 64 randomisierten stärker erschöpften Brustkrebsüberlebenden konnten die Daten von 55 Patientinnen im Mittel knapp 3 Jahre nach Abschluss der Tumortherapie als Intention-to-treat-Population ausgewertet werden. Alle Patientinnen führten ein selbst-organisiertes moderates Walking-Training über 10 Wochen durch, randomisiert wurden 30 der Patientinnen dazu einmal wöchentlich Elemente der Ernährung, Entspannung, Bewegung, Stressbewältigung, Kneipp’schen Wasseranwendungen, der Eigenkompetenz und Achtsamkeit vermittelt. Erschöpfungsparameter, Lebensqualität, Funktionen und psychologische Parameter wurden vor, nach den Interventionen und drei Monate nach Interventionsende erfasst, Blutbild und Lymphozytensubgruppen vor und nach den Interventionen bestimmt. ERGEBNISSE: Die naturheilkundlich-psychoedukative Intervention konnte Ängstlichkeit, psychologische Symptome und Schmerzempfinden signifikant stärker reduzieren. Das moderate Ausdauertraining bewirkte eine relevante Besserung von Erschöpfung, Schlaflosigkeit, Kurzatmigkeit, der Lebensqualität und der Funktionen.BACKGROUND: One third of breast cancer survivors suffer from a persistant form of cancer-related fatigue after successful tumor treatment with mental, cognitive and affective participation and impairment of quality of life and functioning - etiology beeing unclear, suspected multifactorious. Moderate exercise training and psychoeducative interventions are recommended for this persistant form of fatigue, RCTs are missing. A pilot study found significant improvement of fatigue of breast cancer patients for a 10-week naturopathic outclinic intervention. STUDY-AIM: This randomized two-armed intervention trial investigated, whether a multimodal naturopathic psychoeducative intervention combined with exercise could improve persistant fatigue and its parameters in breast cancer survivors better than exercise only. MATERIALS&METHODS: 64 severely fatigued breast cancer survivors were randomized, the data of 55 patient - mean almost 3 years after end of tumor treatment - could be assessed for analysis as intention-to-treat-population. All patient self-organized a moderate exercise training for 10 weeks, 30 patients were randomly given an additional naturopathic psychoeducative intervention with elements of nutrition, relaxation, exercise, stressreduction, hydrotherapy, self competence and mindfulness once a week. Fatigue parameters, quality of life, functioning and psychological parameters were assessed before, after and 3 months after intervention, blood count and lymphocyte subpopulations were assessed before and after intervention. RESULTS: Naturopathic intervention reduced anxiety, psychologic symptoms and pain significantly more than exercise only. Exercise profoundly reduced fatigue, insommnia, dyspnoea, quality of life and functioning

Dynamically Monitoring Production Methods for Identifying Structural Changes relevant to Logistics

Due to the growing dynamic and complexity within the market environment production enterprises in particular are faced with new logistic challenges. Moreover, it is here in this dynamic environment that the Logistic Operating Curve Theory also reaches its limits as a method for describing the correlations between the logistic objectives. In order to convert this theory into a method for dynamically monitoring productions this paper will introduce methods for reliably and quickly identifying structural changes relevant to logistics

Evolutionary History of the Helicobacter pylori Genome: Implications for Gastric Carcinogenesis

The genome of the bacterium Helicobacter pylori has evolved over the millennia since its migration out of Africa along with its human host approximately 60,000 years ago. Human migrations, after thousands of years of permanent settlement in those lands, resulted in seven prototypes of genetic populations of H. pylori with distinct geographical distributions. In all continents, present day isolates of H. pylori have molecular markers that reflect population migrations. The colonization of the Americas as well as the slave trade introduced European and African strains to the New World. The relationship between H. pylori genome and gastric cancer rates is linked to the presence of the cagA gene, but the knowledge on this subject is incomplete because other genes may be involved in certain populations. A new situation for Homo sapiens is the absence of H. pylori colonization in certain, mostly affluent, populations, apparently brought about by improved home sanitation and widespread use of antibiotics during the last decades. The disappearance of H. pylori from the human microbiota may be linked to emerging epidemics of esophageal adenocarcinoma, some allergic diseases such as asthma and some autoimmune disorders

Relationship between tobacco, cagA and vacA i1 virulence factors and bacterial load in patients infected by Helicobacter pylori

Background and Aim Several biological and epidemiological studies support a relationship between smoking and Helicobacter pylori (H. pylori) to increase the risk of pathology. However, there have been few studies on the potential synergistic association between specific cagA and vacA virulence factors and smoking in patients infected by Helicobacter pylori. We studied the relationship between smoking and cagA, vacA i1 virulence factors and bacterial load in H. pylori infected patients. Methods Biopsies of the gastric corpus and antrum from 155 consecutive patients in whom there was clinical suspicion of infection by H. pylori were processed. In 106 patients H. pylori infection was detected. Molecular methods were used to quantify the number of microorganisms and presence of cagA and vacA i1 genes. A standardized questionnaire was used to obtain patients’ clinical data and lifestyle variables, including tobacco and alcohol consumption. Adjusted Odds Ratios (ORadjusted) were estimated by unconditional logistic regression. Results cagA was significantly associated with active-smoking at endoscope: ORadjusted 4.52. Evidence of association was found for vacA i1 (ORadjusted 3.15). Bacterial load was higher in active-smokers, although these differences did not yield statistical significance (median of 262.2 versus 79.4 copies of H. pylori per cell). Conclusions The association between smoking and a higher risk of being infected by a virulent bacterial population and with higher bacterial load, support a complex interaction between H. pylori infection and environmental factors

Within-host evolution of Staphylococcus aureus during asymptomatic carriage

Background Staphylococcus aureus is a major cause of healthcare associated mortality, but like many important bacterial pathogens, it is a common constituent of the normal human body flora. Around a third of healthy adults are carriers. Recent evidence suggests that evolution of S. aureus during nasal carriage may be associated with progression to invasive disease. However, a more detailed understanding of within-host evolution under natural conditions is required to appreciate the evolutionary and mechanistic reasons why commensal bacteria such as S. aureus cause disease. Therefore we examined in detail the evolutionary dynamics of normal, asymptomatic carriage. Sequencing a total of 131 genomes across 13 singly colonized hosts using the Illumina platform, we investigated diversity, selection, population dynamics and transmission during the short-term evolution of S. aureus. Principal Findings We characterized the processes by which the raw material for evolution is generated: micro-mutation (point mutation and small insertions/deletions), macro-mutation (large insertions/deletions) and the loss or acquisition of mobile elements (plasmids and bacteriophages). Through an analysis of synonymous, non-synonymous and intergenic mutations we discovered a fitness landscape dominated by purifying selection, with rare examples of adaptive change in genes encoding surface-anchored proteins and an enterotoxin. We found evidence for dramatic, hundred-fold fluctuations in the size of the within-host population over time, which we related to the cycle of colonization and clearance. Using a newly-developed population genetics approach to detect recent transmission among hosts, we revealed evidence for recent transmission between some of our subjects, including a husband and wife both carrying populations of methicillin-resistant S. aureus (MRSA). Significance This investigation begins to paint a picture of the within-host evolution of an important bacterial pathogen during its prevailing natural state, asymptomatic carriage. These results also have wider significance as a benchmark for future systematic studies of evolution during invasive S. aureus disease

Molecular adaptation of ammonia monooxygenase during independent pH specialization in Thaumarchaeota

Acknowledgements This work was funded by Natural Environment Research Council Fellowship NE/J019151/1 and by institutional funding from within the University of Aberdeen. Both authors designed and performed the research, analysed data and equally contributed to the writing of the manuscript.Peer reviewedPublisher PD