An examination of cancer-related fatigue through proposed diagnostic criteria in a sample of cancer patients in Taiwan

<p>Abstract</p> <p>Background</p> <p>Fatigue among cancer patients has often been reported in the literature; however, great variations have been documented, ranging from 15% to 90%, probably due to the lack of a widely accepted definition and established diagnostic criteria for cancer-related fatigue. The objective of this study was to evaluate the proposed International Statistical Classification of Diseases and Related Health Problems (10^threvision) (ICD-10) criteria in a sample of cancer patients from a medical center and a regional teaching hospital in northern Taiwan. More accurate prevalence estimates of CRF may result in improved diagnoses and management of one of the most common symptoms associated with cancer and its treatment.</p> <p>Methods</p> <p>Since self-reporting from patients is the most effective and efficient method to measure fatigue, the ICD-10 criteria for fatigue were used. The ICD-10 criteria questionnaire was translated into Chinese and was approved by experts. Patients were recruited from outpatient palliative and oncology clinics and from palliative and oncology inpatient units.</p> <p>Results</p> <p>Of the 265 cancer patients that were interviewed between 21 October 2008 and 28 October 2009, 228 (86%) reported having at least 2 weeks of fatigue in the past month, and further evaluation with the ICD-10 criteria showed that 132 (49.8%) had cancer-related fatigue. Internal consistency was very good, which was indicated by a Cronbach alpha of 0.843.</p> <p>Conclusion</p> <p>The prevalence of diagnosable CRF in the patients in this sample, of whom most were under palliative treatment, was 49.8%, which was probably somewhat lower than in some of the previous reports that have used less-strict criteria. In addition, among the various criteria of the proposed diagnostic criteria, the most frequently reported symptoms in our sample populations were regarding sleep disturbance and physical factors. Although they will require further replication in other samples, these formal diagnostic criteria can serve as a step toward a common language and a better understanding of the severity range of CRF.</p

Hyperglycemia Altered DNA Methylation Status and Impaired Pancreatic Differentiation from Embryonic Stem Cells

The prevalence of type 2 diabetes (T2D) is rapidly increasing across the globe. Fetal exposure to maternal diabetes was correlated with higher prevalence of impaired glucose tolerance and T2D later in life. Previous studies showed aberrant DNA methylation patterns in pancreas of T2D patients. However, the underlying mechanisms remained largely unknown. We utilized human embryonic stem cells (hESC) as the in vitro model for studying the effects of hyperglycemia on DNA methylome and early pancreatic differentiation. Culture in hyperglycemic conditions disturbed the pancreatic lineage potential of hESC, leading to the downregulation of expression of pancreatic markers PDX1, NKX6−1 and NKX6−2 after in vitro differentiation. Genome-wide DNA methylome profiling revealed over 2000 differentially methylated CpG sites in hESC cultured in hyperglycemic condition when compared with those in control glucose condition. Gene ontology analysis also revealed that the hypermethylated genes were enriched in cell fate commitment. Among them, NKX6−2 was validated and its hypermethylation status was maintained upon differentiation into pancreatic progenitor cells. We also established mouse ESC lines at both physiological glucose level (PG-mESC) and conventional hyperglycemia glucose level (HG-mESC). Concordantly, DNA methylome analysis revealed the enrichment of hypermethylated genes related to cell differentiation in HG-mESC, including Nkx6−1. Our results suggested that hyperglycemia dysregulated the epigenome at early fetal development, possibly leading to impaired pancreatic development

A study of the health and economic effects of influenza-like illness on the working population under different working environments of a large corporation in Hong Kong

Objective: The incidence, health and economic impacts of influenza-like illness (ILI) among the working population in Hong Kong had never been studied. Due to the nature of the disease, ILIs can have a significant impact on the operation of a corporation in terms of loss of productivity and reduced work performance. The present study was undertaken to determine the health and economic impacts of ILIs under different environmental conditions on the working population of a large corporation. Method: Over 2,000 employees of a large corporation in the travelling and tourism industry were studied with three different types of working environment (confined, typical office and well ventilated) by two structured questionnaires. Results: The most affected group in terms of productivity and health was the group working in a confined area, whilst those working in a well-ventilated area were least affected. However, symptoms of the confined area group seemed to disappear faster. The infection rate appeared to vary according to work environment for the studied population. Conclusion: Policies on preventive measures and early treatment are important for a corporation to reduce loss in productivity due to ILIs

Progression of Parkinson's disease as evaluated by Hoehn and Yahr stage transition times

This study was carried out to evaluate progression in Parkinson’s disease (PD) by analyzing time taken to transit from one Hoehn and Yahr (H&Y) stage to the next stage and to investigate the variables that would be associated with H&Y transition times using a large PD database that contained prospectively collected information. Data were obtained from the movement disorder database of the National Neuroscience Institute in Singapore. Kaplan-Meier (KM) survival analysis was adopted to investigate the time taken to progress through various H&Y stages. Cox regression analysis was used to examine the association between the baseline variables at the entry point of each H&Y stage and the progression to the next stage. A total of 695 patients (mean age: 65.2, male: 57.3%) were studied. Using KM analysis, the median time taken to transit from H&Y stage 1 to 2, 2 to 2.5, 2.5 to 3 were 20, 62, and 25 months, respectively; whereas the median time taken to progress from stage 3 to 4 and 4 to 5 were 24 and 26 months, respectively. Cox regression analysis revealed that older age-at-diagnosis, longer PD duration, and higher Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores at baseline were associated with a significantly faster progression through various H&Y stages. Gender and ethnicity were not associated with disease progression. In conclusion, H&Y transition time is a useful measure of disease progression in PD and may be utilized in clinical studies evaluating therapeutic interventions and prognostic factors in PD

Associations of patient characteristics, rate of torque development, voluntary activation of quadriceps with quadriceps strength, and knee function before anterior cruciate ligament reconstruction

Good preoperative knee function（KF) and quadriceps strength（QS）relate to good prognoses after anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate the associations between patient characteristics, rate of torque development (RTD), voluntary activation (VA) of the quadriceps against preoperative KF and QS. A cross-sectional study was conducted. Forty patients with a primary, unilateral ACL injury who had finished their preoperative rehabilitation and were waiting for an ACLR were included. KF was evaluated using the International Knee Documentation Committee (IKDC) score. All quadriceps-related outcomes were measured with the knee flexion at 45°. QS was measured by maximal voluntary isometric contractions (MVIC). RTD was divided into the early (RTD0-50) and the late phase (RTD100-200), respectively. Quadriceps VA was measured using the superimposed burst technique. Our results showed that patients with poor preoperative KF (IKDC score0-50 (P=0.025), higher body mass index (BMI, P=0.043), and more meniscus injuries (P=0.001) than those with good knee function (N=32). Patients with asymmetrical QS (N=22) showed lower BMI (P=0.020) and shorter time from injury (P=0.027) than those with symmetrical QS(N=18). Additionally, a higher pre-injury Tegner score combined with greater RTD100-200 contributed to greater QS on the injured limb (R2=0.357, P=0.001). To conclude, BMI, time from injury, concomitant meniscus injury, pre-injury physical activity level, and quadriceps RTD are related to QS and KF in patients before ACLR.</p