Interventions for Managing Late Gastrointestinal Symptoms Following Pelvic Radiotherapy: a Systematic Review and Meta-analysis.

AIMS: Pelvic radiotherapy can induce gastrointestinal injury and symptoms, which can affect quality of life. We assessed interventions for managing these symptoms. MATERIALS AND METHODS: A review of randomised controlled trials published between January 1990 and June 2023 from databases including MEDLINE, EMBASE, CENTRAL, CINAHL, clinicaltrials.gov, ISRCTN and grey literature sources was conducted. Meta-analyses were carried out using the DerSimonian and Laird random effects model to produce overall treatment differences with 95% confidence intervals. RESULTS: Twenty-eight studies (2392 participants) of varying methodological quality were included. 4% formalin was superior to sucralfate for improving gastrointestinal symptom score (standardised mean difference [SMD] -1.07, 95% confidence interval -1.48 to -0.65). Argon plasma coagulation (APC) was inferior to sucralfate (SMD 1.22, 95% confidence interval 0.84 to 1.59). Counselling positively influenced symptom score (SMD -0.53, 95% confidence interval -0.76 to -0.29), whereas hyperbaric oxygen therapy showed conflicting results. Sucralfate combined with APC increased endoscopic markers of moderate-severe bleeding versus APC alone (risk ratio 2.26, 95% confidence interval 1.12 to 4.55). No definite conclusions on pain, incontinence, diarrhoea, tenesmus or quality of life interventions were confirmed. CONCLUSIONS: Small study sizes, methodological quality and heterogeneity limit support of any individual intervention. APC and 4% formalin seem to be promising interventions, with further larger randomised controlled trials now warranted.

COVID-19 and older people in Asia: Asian Working Group for Sarcopenia calls to actions.

The coronavirus disease 2019 (COVID-19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID-19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID-19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new approaches to deliver healthcare in these difficult times and to establish resilient healthcare systems for older people. Geriatr Gerontol Int 2020; 9999: n/a-n/a.

Predictors of cervical cancer screening for Chinese American women.

Research on Chinese American women's cervical cancer screening behaviours is limited and there are few studies that examine factors associated with obtaining regular Pap tests. The purpose of this study was to use the transtheoretical model (TTM) as a framework to examine correlates of Pap testing and stages of change. Chinese American women (N = 121) were recruited to complete a cross-sectional, self-report survey. Survey items assessed stages of change, self-efficacy, perceived benefits and barriers, and demographic variables including screening and family history for cervical cancer. Eighty-one per cent of women reported that they had ever had a Pap test. Most participants were in the maintenance stage (55%), with 10% in each action and pre-contemplation, 8% in contemplation, 1% in preparation and 16% in the relapse stage. Women in the action/maintenance stage were more likely to be older, married and have a higher education level. Women in the action/maintenance stage had significantly lower perceived barrier scores compared to women in both the contemplation/preparation and pre-contemplation/relapse stages. Findings partially support the use of TTM for cervical cancer screening among this population and indicate the importance of perceived barriers. Results may inform interventions to increase screening rates among Chinese American women.

Sexual violence cases in a hospital setting in Hong Kong: victims' demographic, event characteristics, and management.

INTRODUCTION: Rainlily, the first one-stop crisis centre in Hong Kong, was set up in 2000 to protect female victims of sexual violence. This study aimed to analyse the characteristics of sexual assault cases and victims who presented to two hospitals in Hong Kong. The data are invaluable for health care professionals and policymakers to improve service provision to these victims. METHODS: This retrospective analysis of hospital records was conducted in two acute hospitals under the Hospital Authority in Hong Kong. Sexual assault victims who attended the two hospitals between May 2010 and April 2013 were included. Characteristics of the cases and the victims, the use of alcohol and drugs, involvement of violence, and the outcome of the victims were studied. RESULTS: During the study period, 154 sexual assault victims attended either one of the two hospitals. Their age ranged from 13 to 64 years. The time from assault to presentation ranged from 1 hour to more than 5 months. Approximately 50% of the assailants were strangers. Approximately 50% of victims presented with symptoms; the most common were pelvic and genitourinary symptoms. Those with symptoms (except pregnancy) presented earlier than those without. The use of alcohol and drugs was involved in 36.4% and 11.7% of cases, respectively. Approximately 10% of the screened victims were positive for Chlamydia trachomatis. There were 11 pregnancies with gestational age ranged from 6 weeks to 5 months at presentation. Less than half of the victims completed follow-up care. CONCLUSIONS: Involvement of alcohol and drugs is not uncommon in sexual assault cases. Efforts should be made to promote public education, enhance coordination between medical and social services, and improve the accessibility and availability of clinical care. Earlier management and better compliance with follow-up can minimise the health consequences and impact on victims.

Synchronously Tailoring Strain Sensitivity and Electrical Stability of Silicone Elastomer Composites by the Synergistic Effect of a Dual Conductive Network.

The use of conductive polymer composites (CPCs) as strain sensors has been widely investigated. A wide range of strain sensitivities and high repeatability are vital for different applications of CPCs. In this study, the relations of the conductive filler network and the strain-sensing behavior and electrical stability under fatigue cycles were studied systematically for the first time based on the conductive polymethylvinylsiloxane (PMVS) composites filled with both carbon nanotubes arrays (CNTAs) and carbon black (CB). It was proved that the composites could be fabricated with large strain-sensing capability and a wide range of strain sensitivities by controlling the volume ratio of CNTA/CB and their amounts. Additionally, the CNTA/CB/PMVS composite with 3 vol % content of fillers showed high sensitivity (GF is 10 at 60% strain), high repeatability (the relative standard deviation (RSD) of the max R/R0 value is 3.58%), and electrical stability under fatigue cycles (value range of R/R0 is 1.62 to 1.82) at the same time due to the synergistic effects of the dual conductive network of CNTAs and CB. This could not be achieved by relying on a single CNTA or CB conductive network. This study may provide guidance for the preparation of high performance CPCs for applications in strain sensors.

Data for effects of lanthanum complex on the thermo-oxidative aging of natural rubber.

Novel mixed antioxidants composed of antioxidant IPPD and lanthanum (La) complex were added as a filler to form natural rubber (NR) composites. By mechanical testing, Fourier transform infrared spectroscopy with attenuated total reflectance (FTIR-ATR) and thermogravimetric analysis (TGA), a string of data, including the mechanical properties, the variation of internal groups and the thermal and thermo-oxidative decompositions of NR, was presented in this data article. The data accompanying its research article [1] studied the thermo-oxidative aging properties of NR in detail. The density function theoretical (DFT) calculations were also used as an assistant to study the thermo-oxidative aging mechanism of NR. The data revealed that this new rare-earth antioxidant could indeed enhance the thermo-oxidative aging resistance of NR, which is associated with its different function mechanism from that of the pure antioxidant IPPD.

High performance graphene oxide based rubber composites.

In this paper, graphene oxide/styrene-butadiene rubber (GO/SBR) composites with complete exfoliation of GO sheets were prepared by aqueous-phase mixing of GO colloid with SBR latex and a small loading of butadiene-styrene-vinyl-pyridine rubber (VPR) latex, followed by their co-coagulation. During co-coagulation, VPR not only plays a key role in the prevention of aggregation of GO sheets but also acts as an interface-bridge between GO and SBR. The results demonstrated that the mechanical properties of the GO/SBR composite with 2.0 vol.% GO is comparable with those of the SBR composite reinforced with 13.1 vol.% of carbon black (CB), with a low mass density and a good gas barrier ability to boot. The present work also showed that GO-silica/SBR composite exhibited outstanding wear resistance and low-rolling resistance which make GO-silica/SBR very competitive for the green tire application, opening up enormous opportunities to prepare high performance rubber composites for future engineering applications.

Nummular headache after trans-sphenoidal surgery: a referred pain-based headache syndrome.

Nummular headache (NH) is a newly categorized primary headache characterized by a consistent location, shape and size of painful area in each attack. The etiopathogenesis is entirely unknown. Currently, the peripheral theory of epicranial neuralgia is accepted more widely than the central theory but it cannot fully explain the clinical picture. We report a patient who suffered from a relapsing and remitting course of NH at the high parietal area and vertex shortly after resection for pituitary prolactinoma via a trans-sphenoidal approach. There was no focal trophic change or paresthesia but a mild allodynia in the painful area. The patient did not exhibit trigeminal sensory disorder or cranial trauma thoroughly. The pain responded well to gabapentin. Therefore, physicians should be aware of postoperative NH, which is amenable to treatment. The findings in our patient support a dual mechanism of NH and suggest that central NH is a form of referred pain.

HIV knowledge and condom intention among sexually abstinent Chinese students.

AIMS: To (a) assess the HIV/AIDS knowledge and sources of HIV/sexually transmitted infection (STI) information among sexually abstinent college students in China; (b) examine whether constructs from the transtheoretical model (TTM) are applicable to this study population regarding condom use intention; and (c) evaluate the association between genders and TTM constructs, and HIV/AIDS knowledge. BACKGROUND: Chinese college students are vulnerable to HIV and other STIs. Strategies targeting abstinent students are more cost-effective than providing treatment for diseases. METHODS: We surveyed 390 students enrolled in two universities in China. Data were collected from June 2009 to March 2010. RESULTS: Only 11% and 24% were aware of HIV spread by infected semen and of the protective effects of condom use against HIV. The mass media were major sources of HIV/STI information. Individuals who had higher levels of self-efficacy and reported more perceived benefits and fewer perceived barriers were more likely to be in TTM contemplation stage of condom use than those in precontemplation. Females were less likely to discuss HIV/STIs through online chat or email with strangers than males. Individuals who had higher levels of self-efficacy and reported more perceived benefits and fewer perceived barriers were more likely to be in TTM contemplation stage of condom use than those in precontemplation. CONCLUSION: Sexually abstinent college students in China may be more likely to transition from precontemplation to contemplation if they know the benefits of condom use for the prevention of HIV/STIs and if they learn to successfully minimize potential barriers related to condom use.

Synthesis of nanocarriers with remote magnetic drug release control and enhanced drug delivery for intracellular targeting of cancer cells.

Nanotherapeutic strategy is well recognized as the therapeutic approach of the future. Numerous reports have demonstrated the use of nanoparticulate drug carriers for the development of targeted nanotherapeutics by, for instance, incorporation of a moiety that specifically targets certain diseased cells. However, systematic investigation of this aspect has been inadequate, especially with regard to nanosystems with remotely controlled drug delivery. The authors previously designed a magnetic-responsive core-shell drug delivery nanosystem which proved to be technically feasible in vitro. In the present study, this nanosystem is modified for targeted delivery of an anticancer agent (encapsulated camptothecin (CPT)) to cancer cells overexpressing epithelial growth factor receptor (EGFR) with accurate intracellular drug release. The endocytosis of the nanocarriers by cancer cells, the pathway of cellular uptake and the subsequent intracellular controlled drug delivery were systematically investigated. It was found that the modified nanocarriers showed reasonably high drug load efficiency for CPT and a high uptake rate by cancer cells overexpressing EGFR through clathrin-mediated endocytosis. The intracellular release of the CPT molecules via an external magnetic stimulus proved to be technically successful and ensured much higher therapeutic efficacy than that obtained with the free drug. This study employs multiple functions for nanotherapeutic treatment of specific target cells, i.e. cell-specific targeting, controlled cellular endocytosis and magnetic-responsive intracellular drug release.

Financial volatility trading using a self-organising neural-fuzzy semantic network and option straddle-based approach.

Financial volatility refers to the intensity of the fluctuations in the expected return on an investment or the pricing of a financial asset due to market uncertainties. Hence, volatility modeling and forecasting is imperative to financial market investors, as such projections allow the investors to adjust their trading strategies in anticipation of the impending financial market movements. Following this, financial volatility trading is the capitalization of the uncertainties of the financial markets to realize investment profits in times of rising, falling and side-way market conditions. In this paper, an intelligent straddle trading system (framework) that consists of a volatility projection module (VPM) and a trade decision module (TDM) is proposed for financial volatility trading via the buying and selling of option straddles to help a human trader capitalizes on the underlying uncertainties of the Hong Kong stock market. Three different measures, namely: (1) the historical volatility (HV), (2) implied volatility (IV) and (3) model-based volatility (MV) of the Hang Seng Index (HSI) are employed to quantify the implicit volatility of the Hong Kong stock market. The TDM of the proposed straddle trading system combines the respective volatility measures with the well-established moving-averages convergence/divergence (MACD) principle to recommend trading actions to a human trader dealing in HSI straddles. However, the inherent limitation of the MACD trading rule is that it generates time-delayed trading signals due to the use of moving averages, which are essentially lagging trend indicators. This drawback is intuitively addressed in the proposed straddle trading system by applying the VPM to compute future projections of the volatility measures of the HSI prior to the activation of the TDM. The VPM is realized by a self-organising neural-fuzzy semantic network named the evolving fuzzy semantic memory (eFSM) model. As compared to existing statistical and computational intelligence based modeling techniques currently employed for financial volatility modeling and forecasting, eFSM possesses several desirable attributes such as: (1) an evolvable knowledge base to continuously address the non-stationary characteristics of the Hong Kong stock market; (2) highly formalized human-like information computations; and (3) a transparent structure that can be interpreted via a set of linguistic IF-THEN semantic fuzzy rules. These qualities provide added credence to the computed HSI volatility projections. The volatility modeling and forecasting performances of the eFSM, when benchmarked to several established modeling techniques, as well as the observed trading returns of the proposed straddle trading system, are encouraging.

Stages of condom use and decisional balance among college students.

AIMS: To explore sexual behaviours and condom use and differences in specific items of perceived benefits and barriers to condoms using the Transtheoretical Model (TTM) stages among college students in southern Taiwan. BACKGROUND: The TTM suggests that individuals in the action or maintenance stage exhibit higher levels of perceived benefits and lower levels of perceived barriers related to condom use than people in the precontemplation, contemplation or preparation stage. METHODS: This was a descriptive, cross-sectional design with cluster sampling among college students from two universities in southern Taiwan. Participants completed self-administered questionnaires, including demographic data, Sexual History and Condom Use Scale and Condom Use Decisional Balance Scale. RESULTS: Of the 279 participants, 57% were sexually active, of these only 11.9% used condoms consistently. Respondents in the TTM stage of action/maintenance perceived greater benefits in relation to feeling more responsible (P = 0.031) and protecting their partners as well as themselves (P = 0.028), and perceived more barriers in believing that using condom needs to rely on partner's cooperation (P = 0.046) than participants in precontemplation. Participants in precontemplation and contemplation perceived more barriers related to worry about making their partner angry if condoms were used than those in action/maintenance (P = 0.008). CONCLUSION: Low levels of condom use among Taiwanese college students remain a significant public health concern. HIV prevention programmes for college students in Taiwan may be enhanced if they incorporate readiness to change and perceived benefits and barriers. Future research should include a larger sample with diverse groups.

Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Hong Kong.

Community-associated methicillin resistant Staphylococcus aureus is an emerging cause of skin and soft tissue infections in Hong Kong, especially among certain ethnic minorities.

Radiation therapy to non-iatrogenic subcutaneous metastasis in hepatocellular carcinoma: results of a case series.

Non-iatrogenic subcutaneous metastasis of hepatocellular carcinoma (HCC) is rare. The aim of this study was to determine the characteristics of such non-iatrogenic subcutaneous metastases and to review the results of radiation therapy. Patients with HCC who were referred for radiation therapy to a subcutaneous mass from 1 January 1998 to 31 December 2005 were reviewed. Iatrogenic cases were excluded. The patients' characteristics, the properties of the lesion, radiation treatment, treatment response, and survival were studied. 24 subcutaneous metastatic lesions in 21 patients were studied. The patients' mean age was 58.2 years. The average latency period for the occurrence of the metastases was 291 days. The scalp was the most frequent metastatic site. At least a partial response was achieved in 20 of 24 lesions (83.3%), with radiation doses ranging from 8 to 64 Gy. No severe sequelae were recorded. The overall 6-month survival was 43.4%. ECOG (Eastern Cooperative Oncology Group) performance status and radiation dose were statistically significant factors for local treatment response. Performance status was also an independent factor for survival. Radiation therapy of subcutaneous metastases of HCC can achieve satisfactory results, especially in patients with a good performance status.

Applying the transtheoretical model to cervical cancer screening in Vietnamese-American women.

BACKGROUND: Low levels of Papanicolaou (Pap) screening participation in Vietnamese-American women remain a significant public health problem. The transtheoretical model (TTM) suggests that individuals adopting Pap smear behaviour move through a series of stages of readiness to change. Determining a woman's level of readiness for regular Pap testing and identifying the screening behaviour that an individual already performs is important in the development of successful intervention programmes that address the specific needs of Vietnamese-American women in different stages. AIMS: To describe Pap smear screening behaviours of Vietnamese-American women, and to examine whether constructs (stages of change, self-efficacy and perceived benefits/barriers) from the TTM are applicable to Vietnamese-American women relative to Pap testing. METHODS: A descriptive, cross-sectional design with snowball sampling was used to recruit participants. A total of 80 Vietnamese-American women completed the self-administered questionnaire. RESULTS: Most respondents (62.5%) reported previous Pap testing and only 46.3% receiving regular Pap testing. Compared with those in the pre-contemplation stage of the TTM, participants in maintenance reported significantly less self-efficacy (F (3, 73) = 4.85, P = 0.00), a lower level of perceived barriers (F (3, 75) = 5.99, P = 0.00) and a higher level of perceived benefits (F (3, 76) = 3.91, P = 0.01) relative to Pap smear. CONCLUSIONS: The results support some of the assumptions of the TTM but raise questions about the predicted relationships between stages of change and self-efficacy. Continued research is needed to identify the most effective theory-based interventions for evidence-based nursing practice in this population.

Effect of bilateral reaching on affected arm motor control in stroke--with and without loading on unaffected arm.

PURPOSE: To investigate the effect of bilateral reaching, with/without inertial loading on the unaffected arm, on hemiparetic arm motor control in stroke. METHODS: Twenty unilateral stroke patients were recruited. A three-dimensional optical motion capture system was used to measure the movement trajectory of the hemiparetic arm while performing three tasks: affected limb reaching forward; two-limb reaching forward; and two-limb reaching forward with inertia loading of 25% upper limb weight on the unaffected limb, respectively. Kinematical parameters were utilized to quantify the reaching performance of the affected arm. RESULTS: No matter whether loading was applied on the unaffected arm or not, the bilateral reaching task did not significantly facilitate smoother and faster movement. Furthermore, during bilateral reaching task with/without loading on the unaffected arm, stroke patients showed slower movement, lower maximal movement velocity, feedback control dominant and discontinuous movements in the affected arm than the same task with unilateral reaching. Subjects showed the greatest active upper extremity range of motion in proximal joints during the bilateral reaching task without unaffected arm loading. The amount of trunk movement also increased during bilateral reaching either with or without loading on the unaffected arm. Patients with moderate upper extremity motor impairment performed more discontinuous movements and less active elbow range of motion during bilateral reaching tasks; however, those with mild upper extremity motor impairment performed smoother movements and demonstrated greater active elbow range of motion during bilateral reaching tasks. CONCLUSIONS: Bilateral reaching tasks with/without loading on the unaffected arm could be considered as adding challenges during motor control training. Training with bilateral arm movements may be considered as a treatment strategy, and can be incorporated in stroke rehabilitation to facilitate greater arm active movement and improve motor control performance in the affected arm.

FCMAC-Yager: a novel Yager-inference-scheme-based fuzzy CMAC.

The cerebellum is a brain region important for a number of motor and cognitive functions. It is able to generate error correction signals to drive learning and for the acquisition of memory skills. The cerebellar model articulation controller (CMAC) is a neural network inspired by the neurophysiologic theory of the cerebellum and is recognized for its localized generalization and rapid algorithmic computation capabilities. The main deficiencies in the basic CMAC structure are: (1) it is difficult to interpret the internal operations of the CMAC network and (2) the resolution (quantization) problem arising from the partitioning of the input training space. These limitations lead to the synthesis of a fuzzy quantization technique and the mapping of a fuzzy inference scheme onto the CMAC structure. The discrete incremental clustering (DIC) technique is employed to alleviate the quantization problem in the CMAC structure, resulting in the fuzzy CMAC (FCMAC) network. The Yager inference scheme (Yager), which possesses firm fuzzy logic foundation and maps closely to the logical implication operations in the classical (binary) logic framework, is subsequently mapped onto the FCMAC structure. This results in a novel fuzzy neural architecture known as thefuzzy cerebellar model articulation controller-Yager (FCMAC-Yager) system. The proposed FCMAC-Yager network exhibits learning and memory capabilities of the cerebellum through the CMAC structure while emulating the human way of reasoning through the Yager. The new FCMAC-Yager network employs a two-phase training algorithm consisting of structural learning based on the DIC technique and parameter learning using hebbian learning (associative long-term potentiation). The proposed FCMAC-Yager architecture is evaluated using an extensive suite of real-life applications such as highway traffic-trend modeling and prediction and performing as an early warning system for bank failure classification and medical diagnosis of breast cancer. The experimental results are encouraging.

Effects of an osteoporosis educational programme for men.

AIM: This paper reports an evaluation of the effects on knowledge, health beliefs and preventive behaviours of an osteoporosis educational programme for men. BACKGROUND: Osteoporosis is an increasing global health concern, and educational programmes have been identified as a crucial strategy in its prevention. However, the effectiveness of osteoporosis educational programmes has mainly been evaluated in women. METHODS: A randomized controlled trial was carried out to identify the effects of an osteoporosis educational programme for men. The study was conducted between September 2004 to February 2005, and 128 Hong Kong Chinese men were randomly assigned to an intervention or control group, with 64 in each group. The intervention group attended an osteoporosis educational programme. All participants completed pre- and post-test self-administered questionnaires: Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale and Osteoporosis Self-Efficacy Scale. RESULTS: The intervention group showed a statistically significant increase in both knowledge (P < 0.0005) and health beliefs (P = 0.007) about osteoporosis and preventive behaviours in comparison with the control group. However, the difference in self-efficacy between the two groups was not statistically significant (P = 0.154). CONCLUSIONS: An osteoporosis educational programme can increase men's knowledge levels and change their health beliefs about osteoporosis and preventive behaviours. This approach should be more widely used in nursing practice to promoting the adoption of osteoporosis prevention behaviours in men.

Inertia and memory in ambiguous visual perception.

Perceptual multistability during ambiguous visual perception is an important clue to neural dynamics. We examined perceptual switching during ambiguous depth perception using a Necker cube stimulus, and also during binocular rivalry. Analysis of perceptual switching time series using variance-sample size analysis, spectral analysis and time series shuffling shows that switching times behave as a 1/f noise and possess very long range correlations. The long memory feature contrasts sharply with the traditional satiation models of multistability, where the memory is not incorporated, as well as with recently published models of multistability and neural processing, where memory is excluded. On the other hand, the long memory feature favors the concept of "dynamic core" or coalition of neurons, where neurons form transient coalitions. Perceptual switching then corresponds to replacement of one coalition of neurons by another. The inertia and memory measures the stability of a coalition: a strong and stable coalition has to be won over by another similarly strong and stable coalition, resulting in long switching times. The complicated transient dynamics of competing coalitions of neurons may be addressable using a combination of functional imaging, measurement of frequency-tagged magnetoencephalography and frequency-tagged encephalography, simultaneous recordings of groups of neurons in many areas of the brain, and concepts from statistical mechanics and nonlinear dynamics theory.