Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial.

BACKGROUND: No phase 3 trial has yet shown improved survival for patients with pleural or peritoneal malignant mesothelioma who have progressed following platinum-based chemotherapy. The aim of this study was to assess the efficacy and safety of nivolumab, an anti-PD-1 antibody, in these patients. METHODS: This was a multicentre, placebo-controlled, double-blind, parallel group, randomised, phase 3 trial done in 24 hospitals in the UK. Adult patients (aged ≥18 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed pleural or peritoneal mesothelioma, who had received previous first-line platinum-based chemotherapy and had radiological evidence of disease progression, were randomly assigned (2:1) to receive nivolumab at a flat dose of 240 mg every 2 weeks over 30 min intravenously or placebo until disease progression or a maximum of 12 months. The randomisation sequence was generated within an interactive web response system (Alea); patients were stratified according to epithelioid versus non-epithelioid histology and were assigned in random block sizes of 3 and 6. Participants and treating clinicians were masked to group allocation. The co-primary endpoints were investigator-assessed progression-free survival and overall survival, analysed according to the treatment policy estimand (an equivalent of the intention-to-treat principle). All patients who were randomly assigned were included in the safety population, reported according to group allocation. This trial is registered with Clinicaltrials.gov, NCT03063450. FINDINGS: Between May 10, 2017, and March 30, 2020, 332 patients were recruited, of whom 221 (67%) were randomly assigned to the nivolumab group and 111 (33%) were assigned to the placebo group). Median follow-up was 11·6 months (IQR 7·2-16·8). Median progression-free survival was 3·0 months (95% CI 2·8-4·1) in the nivolumab group versus 1·8 months (1·4-2·6) in the placebo group (adjusted hazard ratio [HR] 0·67 [95% CI 0·53-0·85; p=0·0012). Median overall survival was 10·2 months (95% CI 8·5-12·1) in the nivolumab group versus 6·9 months (5·0-8·0) in the placebo group (adjusted HR 0·69 [95% CI 0·52-0·91]; p=0·0090). The most frequently reported grade 3 or worse treatment-related adverse events were diarrhoea (six [3%] of 221 in the nivolumab group vs two [2%] of 111 in the placebo group) and infusion-related reaction (six [3%] vs none). Serious adverse events occurred in 90 (41%) patients in the nivolumab group and 49 (44%) patients in the placebo group. There were no treatment-related deaths in either group. INTERPRETATION: Nivolumab represents a treatment that might be beneficial to patients with malignant mesothelioma who have progressed on first-line therapy. FUNDING: Stand up to Cancer-Cancer Research UK and Bristol Myers Squibb.

A Portable Phase-Domain Magnetic Induction Tomography Transceiver with Phase-Band Auto-Tracking and Frequency-Sweep Capabilities.

This paper presents a portable magnetic induction tomography (MIT) transceiver integrated circuit to miniaturize conventional equipment-based MIT systems. The miniaturized MIT function is enabled through single-chip transceiver implementation. The proposed MIT transceiver utilizes a phase-locked loop (PLL) for frequency sweeping and a phase-domain sigma⁻delta modulator with phase-band auto-tracking for a full-range fine-phase resolution. The designed transceiver is fabricated and verified to achieve the measured signal to noise and distortion ratio (SNDR) of 101.7 dB. Its system-level prototype including in-house magnetic sensor coils is manufactured and functionally verified for four different material types.

A Three-Step Resolution-Reconfigurable Hazardous Multi-Gas Sensor Interface for Wireless Air-Quality Monitoring Applications.

This paper presents a resolution-reconfigurable wide-range resistive sensor readout interface for wireless multi-gas monitoring applications that displays results on a smartphone. Three types of sensing resolutions were selected to minimize processing power consumption, and a dual-mode front-end structure was proposed to support the detection of a variety of hazardous gases with wide range of characteristic resistance. The readout integrated circuit (ROIC) was fabricated in a 0.18 µm CMOS process to provide three reconfigurable data conversions that correspond to a low-power resistance-to-digital converter (RDC), a 12-bit successive approximation register (SAR) analog-to-digital converter (ADC), and a 16-bit delta-sigma modulator. For functional feasibility, a wireless sensor system prototype that included in-house microelectromechanical (MEMS) sensing devices and commercial device products was manufactured and experimentally verified to detect a variety of hazardous gases.

Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis.

Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.

One-year follow-up of Chinese people with spinal cord injury: a preliminary study.

BACKGROUND: A tertiary spinal cord injury (SCI) center was established in the northern region of Hong Kong, China and a multidisciplinary SCI rehabilitation program was developed to reintegrate patients into the community. OBJECTIVE: To investigate functional outcomes for Chinese people with SCI across a 1-year period. DESIGN: Longitudinal prospective design. METHODS: Thirty community-dwelling participants with traumatic SCI were recruited. Functional status was measured using functional independence measure (FIM) on admission, upon discharge, 1-month, 3-month, 6-month, and 1-year post-discharge. Information on use of assistive devices and life role were also obtained. RESULTS: Twenty-three (76.67%) participants were men. Seventeen participants (10 with tetraplegia and 7 with paraplegia) were classified ASIA A, B, or C; 13 (7 with tetraplegia and 6 with paraplegia) were classified as ASIA D. Significant differences in FIM motor scores were only found between the tetraplegia group and three other diagnostic groups using Bonferroni post-hoc tests of repeated measure ANOVA (analysis of variance) (P < 0.05). Longitudinally, contrast tests of repeated measure ANOVA showed significant differences during the hospitalization period for all diagnostic groups. People in the ASIA D group showed significant functional improvement even after 1-year post-discharge (P < 0.05). At 1-year post-discharge, only two participants were engaged in either remunerative employment or academic pursuit. CONCLUSION: Despite functional status improvement, few people with traumatic SCI were re-engaged in productive life role 1 year after discharge. Studies with longer follow-up would be beneficial.

Assessment of a Discogenic Pain Animal Model Induced by Applying Continuous Shear Force to Intervertebral Discs.

BACKGROUND: Chronic discogenic pain includes degeneration-driven changes under the mechanical macroenvironment of an internal disc, which leads to the progressive changes of biochemical microenvironment that induce abnormal ingrowth of the nociceptor. The propriety of the animal model reflecting the pathologic natural history has not been assessed. OBJECTIVES: This study investigated the biochemical evidence of chronic discogenic pain by employing a discogenic pain animal model induced by shear force. STUDY DESIGN: Animal study utilizing rats in vivo model of a shear force device. METHODS: Fifteen rats were divided into 3 groups (n = 5/group) according to the period for which sustained dorsoventral shear force was applied (1 week or 2 weeks); the control group received the spinous attachment unit, without a spring. Pain data were collected using von Frey hairs on the hind paws. Growth factor and cytokine abundance was analyzed in the dorsal root ganglion (DRG) and plasma. RESULTS: After the shear force devices were installed, the significant variables were found to markedly increase in the DRG tissues of the 2-week group; however, they were not altered in the 1-week group. Specifically, interleukin (IL)-6, neurogrowth factor (NGF), transforming growth factor (TGF)-alpha, platelet-derived growth factor (PDGF)-beta, and vascular endothelial growth factor (VEGF) were increased. Meanwhile, the plasma levels of tumor necrosis factor-alpha, IL-1beta, IL-5, IL-6, IL-12, and NGF were increased in the 1-week group; whereas, TGF-alpha, PDGF-beta, and VEGF were increased in the 2-week group. LIMITATIONS: The limitations include the general limitations of quadrupedal animals, the poor precision and flexural deformation of shear force devices, inaccuracies regarding the evaluation of histological denaturation, and short intervention and observational periods. CONCLUSIONS: This animal model effectively generated biochemical responses to shear loading with evidence of neurological changes induced without direct macrodamage to the outer annulus fibrosus. Chemical internals were induced by mechanical externals among the contributing factors of chronic discogenic pain.

Influence of microsurgical varicocelectomy on human sperm mitochondrial DNA copy number: a pilot study.

BACKGROUND: There is good evidence to show that varicocele repair can improve conventional sperm parameters, as well as, sperm DNA integrity, in infertile men with a clinical varicocele. OBJECTIVE: To examine the effect of varicocelectomy on sperm quality, specifically, sperm nuclear chromatin integrity and sperm mitochondrial DNA (mtDNA) copy number. DESIGN, SETTING, AND PARTICIPANTS: A prospective study done between March 2007 and January 2008. We evaluated a consecutive series of infertile men (n = 14) presenting to Ovo clinic with one year or more history of infertility, a clinically palpable varicocele and poor motility (<25 % rapid progressive and <50 % progressive). SURGICAL PROCEDURE: Microsurgical sub-inguinal varicocelectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Conventional sperm parameters, sperm mtDNA copy number (by real time PCR) and sperm chromatin structure assay (SCSA) parameters (%DFI,% HDS) before and 4 months after microsurgical varicocelectomy. RESULTS AND LIMITATIONS: Sperm concentration and SCSA parameters (%DFI and %HDS) improved significantly after surgery (P < 0.05). Sperm mitochondrial DNA copy number decreased significantly after surgery (27 ± 30 to 9 ± 6 copies per sperm, respectively, P = 0.032). There was a significant negative correlation between mitochondrial DNA copy number and sperm motility (r = - 0.71, P = 0.002). CONCLUSION: These findings support the concept that correction of a varicocele can improve spermatogenesis and sperm function, as mitochondrial DNA copy number has been suggested to reflect the efficiency of spermatogenesis and has been inversely related to sperm motility.

Translation and validation of the Reaction to Impairment and Disability Inventory for Chinese population in Hong Kong.

PURPOSE: This study translated the reaction to impairment and disability inventory (RIDI) to Chinese and validated it for use in Hong Kong. METHODS: We conducted an instrument validation of the Chinese RIDI, with a sample of 244 persons with CID. The research questionnaire collected demographic information, illness-related variables, the Chinese version of RIDI (C-RIDI), and measures of resilience and well-being. We examined the factor structure, internal consistency, convergent validity, and criterion-related validity of the C-RIDI. RESULTS: The C-RIDI has good content validity and no major changes to the translated items were needed for the use in Hong Kong. For factor structure, we replicated the results of Livneh et al. The C-RIDI has two second-order factors of adaptive and nonadaptive scales, which interact with the two denial subscales. Internal consistency of the subscales is satisfactory except for the three-item denial subscales. Correlations of the C-RIDI subscales with illness-related variables, resilience, and mental well-being are consistent with our hypotheses and provide support for the convergent and criterion-related validity of the scale. CONCLUSIONS: The C-RIDI has satisfactory psychometric properties. The study results support its internal consistency, convergent validity, criterion-related validity, and factorial validity.IMPLICATIONS FOR REHABILITATIONEmotional adjustment to chronic illness and disability is a key determinant of illness self-management, mental well-being, and quality of life.The study translated the reaction to impairment and disability inventory into Chinese and conducted a psychometric evaluation of the translated instrument.The Chinese RIDI had a similar second-order factor structure as in the validation studies of the English version, and result of this confirmatory factor analysis support the theory underlying the design of the RIDI.The Chinese RIDI had satisfactory convergent and criterion-related validity and internal consistency, and is ready for application in rehabilitation practice and research in the Chinese context.

Mitochondrial DNA damage is sensitive to exogenous H(2)O(2) but independent of cellular ROS production in prostate cancer cells.

Intrinsic oxidative stress through enhanced production of reactive oxygen species (ROS) in prostate and other cancers may contribute to cancer progression due to its stimulating effect on cancer growth. In this study, we investigate differential responses to exogenous oxidative stimuli between aggressive prostate cancer and normal cell lines and explore potential mechanisms through interactions between cytotoxicity, cellular ROS production and oxidative DNA damage. The circular, multi-copy mitochondrial DNA (mtDNA) is used as a sensitive surrogate to oxidative DNA damage. We demonstrate that exogenous H(2)O(2) induces preferential cytotoxicity in aggressive prostate cancer than normal cells; a cascade production of cellular ROS, composed mainly of superoxide (O(2)(-)), is shown to be a critical determinant of H(2)O(2)-induced selective toxicity in cancer cells. In contrast, mtDNA damage and copy number depletion, as measured by a novel two-phase strategy of the supercoiling-sensitive qPCR method, are very sensitive to exogenous H(2)O(2) exposure in both cancer and normal cell lines. Moreover, we demonstrate for the first time that the sensitive mtDNA damage response to exogenous H(2)O(2) is independent of secondary cellular ROS production triggered by several ROS modulators regardless of cell phenotypes. These new findings suggest different mechanisms underpinning cytotoxicity and DNA damage induced by oxidative stress and a susceptible phenotype to oxidative injury associated with aggressive prostate cancer cells in vitro.

Recombinant human collagen and biomimetic variants using a de novo gene optimized for modular assembly.

A collagen-mimetic polymer that can be easily engineered with specific cell-responsive and mechanical properties would be of significant interest for fundamental cell-matrix studies and applications in regenerative medicine. However, oligonucleotide-based synthesis of full-length collagen has been encumbered by the characteristic glycine-X-Y sequence repetition, which promotes mismatched oligonucleotide hybridizations during de novo gene assembly. In this work, we report a novel, modular synthesis strategy that yields full-length human collagen III and specifically defined variants. We used a computational algorithm that applies codon degeneracy to design oligonucleotides that favor correct hybridizations while disrupting incorrect ones for gene synthesis. The resulting recombinant polymers were expressed in Saccharomyces cerevisiae engineered with prolyl-4-hydroxylase. Our modular approach enabled mixing-and-matching domains to fabricate different combinations of collagen variants that contained different secretion signals at the N-terminus and cysteine residues imbedded within the triple-helical domain at precisely defined locations. This work shows the flexibility of our strategy for designing and assembling specifically tailored biomimetic collagen polymers with re-engineered properties.

Spontaneous Intramuscular Abscesses Involving the Rotator Cuff Muscles in Two Cases Presenting During the COVID-19 Pandemic.

Spontaneous abscesses involving the rotator cuff muscles are a rare surgical occurrence. Patients with such abscesses are often initially misdiagnosed or there is a significant diagnostic delay. Herein, we report one case of a spontaneous intramuscular abscess involving the subscapularis muscle and a second case of an abscess involving the supraspinatus muscle. There is a multitude of predisposing risk factors to developing an intramuscular abscess formation, which includes immunodeficiency, trauma, injection drug use, concurrent infection, and malnutrition. The most significant risk factor in our cases was poorly controlled type 2 diabetes mellitus. Poorly controlled diabetes is known to cause impaired clearance of pathogens, predisposing patients to abscess formation. Both patients also delayed presenting to the hospital due to concerns surrounding the coronavirus disease of 2019 (COVID-19) pandemic. We describe the use of a deltoid-pectoral approach to access the subscapular abscess allowing surgical drainage. The supraspinatus abscess was drained by direct incision. We advocate utilising common and familiar approaches with or without arthroscopy where possible. These cases highlight the importance of early imaging in patients presenting with the physiological signs of infection and idiopathic shoulder pain.

Can a modified theory of planned behavior explain the effects of empowerment education for people with type 2 diabetes?

BACKGROUND: The effectiveness of the Patient Empowerment Program (PEP) has been demonstrated in people with diabetes mellitus (DM); however, the underlying reasons for its effectiveness remain unclear. To improve effectiveness, we need to study the psychological mechanism(s) of PEP to understand why it is effective. This study hypothesized that the Theory of Planned Behavior (TPB), modified specifically for people with DM, could describe the mechanism explaining PEP effects. METHODS: A longitudinal design was used. Patients with type 2 DM (n = 365; 151 males; mean age = 62.9 ± 9.6 years) received two education sessions (i.e. seminars delivered by registered nurses to provide disease-specific knowledge), and some (n = 210) further enrolled afterwards in five empowerment sessions (i.e. small-group interactive workshops conducted by social workers to practice action planning, problem solving, and experience sharing). Validated questionnaires were used to measure risk perception, health literacy, attitude, subjective norm, perceived behavioral control and behavioral intention on diabetes self-care behaviors, and four diabetes self-care behaviors (diet control, exercise, blood glucose monitoring, and foot care) at baseline. Three months later (i.e. at the end of PEP), all participants completed the behavioral intention and diabetes self-care behaviors measures again. Attitude, subjective norm, perceived behavioral control, behavioral intention, and diabetes self-care behaviors were assessed to represent the TPB constructs. Risk perception and health literacy elements relevant to people with DM were assessed and added to modify the TPB. RESULTS: The behavioral intention was associated with three diabetes self-care behaviors: exercise, blood glucose monitoring, and foot care. The behavioral intention was found to be a significant mediator in the following relationships: empowerment session participation and exercise (ß = 0.045, p = 0.04), and empowerment session participation and foot care (ß = 0.099, p < 0.001). CONCLUSIONS: The effects of enrollment of empowerment sessions in PEP on exercise and foot care were likely to be mediated through behavioral intention.

Measuring mtDNA damage using a supercoiling-sensitive qPCR approach.

Compromised mitochondrial DNA structural integrity can have functional consequences for mitochondrial gene expression and replication leading to metabolic and degenerative diseases, aging, and cancer. Gel electrophoresis coupled with Southern blot and probe hybridization and long PCR are established methods for detecting mtDNA damage. But each has its respective shortcomings: gel electrophoresis is at best semi-quantitative and long PCR does not offer information on the structure. To overcome these limitations, we developed a new method with real-time PCR to accurately quantify the mtDNA structural damage/repair and copy number change. We previously showed that the different mtDNA structures (supercoiled, relaxed circular, and linear) have profound influences on the outcome of the real-time PCR amplification. The supercoiled structure is inhibitory to the PCR amplification, while relaxed structures are readily amplified. We will illustrate the use of this new method by quantifying the kinetics of mtDNA damage and repair in LNCaP prostate cancer cells induced by exogenous H2O2 treatments. The use of this new method on clinical samples for spontaneous mtDNA damage level will also be highlighted.

Reliability of measurements for sub-painful and painful perception on artificial electrical stimulations.

Artificial electrical stimulation is a common type of stimulus to induce sub-painful and painful sensation in clinical or neuroscience experiments. The Numerical Rating Scale (NRS) is often used to evaluate subjective perception due to external stimulations. Yet the relationship between the intensity levels of electrical stimulations and self-perception has seldom been examined. The aim of the study was to obtain evidence on the reliability and accuracy of sub-painful and painful perceptions of healthy participants using the NRS under different levels of electrical stimulus. A total of 72 pain-free healthy volunteers (female=44) were recruited. In the first experiment, each participant was given different levels of a non-nociceptive or nociceptive electrical stimulus and then asked to give a perception rating based on an 11-point NRS. In the second experiment, each participant was asked to memorize 5 levels of sub-nociceptive or nociceptive stimuli and to recognize the level of stimulus given each time. For the NRS rating task, intraclass coefficients (ICCs) reached satisfactory level for sub-nociceptive (0.85

Evaluation of the chronic disease self-management program in a Chinese population.

OBJECTIVE: This study evaluated the 6-week Chronic Disease Self-Management Program (CDSMP) in Hong Kong. METHODS: A total of 148 subjects with chronic illness were recruited. Subjects were matched on duration of illness and gender, and then randomly allocated to experimental and comparison groups. The experimental group participated in the CDSMP, while the comparison group joined a Tai-Chi interest class in a mass-activity format. Subjects completed evaluation questionnaires before beginning their program and 1 week following the program. RESULTS: Analysis of covariance showed that the CDSMP participants demonstrated significantly higher self-efficacy in managing their illness, used more cognitive methods to manage pain and symptoms, and felt more energetic than the subjects in the comparison group. The CDSMP participants also demonstrated changes in their profile of coping strategies, having a tendency to adopt the cognitive methods of diverting attention, reinterpreting pain, ignoring sensations, and making positive self-statements. CONCLUSION: The short-term evaluation results showed that the CDSMP primarily increased the self-efficacy, exercise behavior, and application of cognitive coping strategies of the participants. PRACTICE IMPLICATION: The effect of the CDSMP in a Chinese population is similar to that found in studies in Western cultures, and the CDSMP could be applied effectively in a Chinese population.

User satisfaction, community participation and quality of life among Chinese wheelchair users with spinal cord injury: a preliminary study.

The purpose of the present study was to investigate the relationships between spinal cord injury (SCI), wheelchair users' satisfaction, perceptions of their community participation and quality of life (QoL).Thirty-one community wheelchair users with SCI were administered the Chinese version of the Quebec User Evaluation of Satisfaction with assistive Technology (C-QUEST), the abbreviated Hong Kong version of the World Health Organization Quality of Life Questionnaire (WHO QoL-BREF (HK)) and selected items of 'Participation Restrictions' and 'Environmental Factors' of the International Classification of Functioning Disability and Health (ICF). Only a weak correlation was found between the C-QUEST services sub-scores and one ICF environmental factor, that is, health-related professionals (Spearman's r = 0.453; p < 0.05). The C-QUEST device sub-scores were also weakly correlated with four domain scores of the WHO QoL-BREF (HK) (Spearman's r = 0.412-0.567; p < 0.05). Social relationship, participation in leisure and driving activities had a moderate association with scores of the WHO QoL-BREF (HK) (-0.405 > Spearman's r > -0.583; p < 0.05). It is concluded that community participation (e.g. use of transportation) and human environment (e.g. friends and peers) were more related to QoL, than to users' satisfaction with a wheelchair. Further research with a larger sample is recommended to examine the variables related to SCI and QoL.

Salience of Somatosensory Stimulus Modulating External-to-Internal Orienting Attention.

Shifting between one's external and internal environments involves orienting attention. Studies on differentiating subprocesses associated with external-to-internal orienting attention are limited. This study aimed to reveal the characteristics of the disengagement, shifting and reengagement subprocesses by using somatosensory external stimuli and internally generated images. Study participants were to perceive nociceptive external stimuli (External Low (EL) or External High (EH)) induced by electrical stimulations (50 ms) followed by mentally rehearsing learned subnociceptive images (Internal Low (IL) and Internal High (IH)). Behavioral responses and EEG signals of the participants were recorded. The three significant components elicited were: fronto-central negativity (FCN; 128-180 ms), fronto-central P2 (200-260 ms), and central P3 (320-380 ms), which reflected the three subprocesses, respectively. Differences in the FCN and P2 amplitudes during the orienting to the subnociceptive images revealed only in the EH but not EL stimulus condition that are new findings. The results indicated that modulations of the disengagement and shifting processes only happened if the external nociceptive stimuli were of high salience and the external-to-internal incongruence was large. The reengaging process reflected from the amplitude of P3 correlated significantly with attenuation of the pain intensity felt from the external nociceptive stimuli. These findings suggested that the subprocesses underlying external-to-internal orienting attention serve different roles. Disengagement subprocess tends to be stimulus dependent, which is bottom-up in nature. Shifting and reengagement tend to be top-down subprocesses, which taps on cognitive control. This subprocess may account for the attenuation effects on perceived pain intensity after orienting attention.

Chinese Calligraphy Writing for Augmenting Attentional Control and Working Memory of Older Adults at Risk of Mild Cognitive Impairment: A Randomized Controlled Trial.

BACKGROUND: Nonpharmacological intervention for individuals with mild cognitive impairment (MCI) needs further investigation. OBJECTIVE: Test efficacy of an eight-week Chinese calligraphy writing training course in improving attentional control and working memory. METHODS: Ninety-nine participants with MCI were randomized into the eight-week calligraphy writing (n = 48) or control (tablet computer) training (n = 51). Outcomes of the interventions were attentional control, working memory, visual scan and processing speed. They were measured at baseline, post-training, and six-month follow-up. RESULTS: Calligraphy writing, when compared with control, significantly improved working memory as reflected from DST-Backward sequence (p = 0.009) and span scores (p = 0.002), and divided attention as reflected from CTT2 (p < 0.001), and at the post-training. The unique improvement in working memory (span: p < 0.001; sequence: p = 0.008) of the intervention group was also found at follow-up when comparing with those at baseline. Changes in the other outcome measures were not statistically significant. CONCLUSION: The findings provide support that Chinese calligraphy writing training for eight weeks using a cognitive approach would improve working memory and to a lesser extent attentional control functions of patients with early MCI. They also demonstrate the usefulness of using mind-and-body practice for improving specific cognitive functions.

A latent profile analysis on patient empowerment programme in a Hong Kong primary care setting.

OBJECTIVE: This study identified the profiles of subgroups of type 2 diabetic (T2DM) patients of the Patient Empowerment Programme (PEP) by different levels of benefits gained in diabetic self-management behaviors, self-efficacy, and health literacy. METHODS: This study adopted a non-experimental repeated-measures design on T2DM patients who joined PEP, using structured questionnaires. Latent profile analysis (LPA) was used to identify patterns of participants' change on the outcome measures. RESULTS: Findings of LPA revealed that participants who were older, unemployed, weaker in diabetic self-management, and having a higher self-perception in personal disease risk were more likely to join the empowerment sessions and gained more benefits from the program. Participants with lower impairment in energy function and lower autonomy in personal health care showed more improvement in the outcomes. CONCLUSION: The study identified significant factors associated with patients' participation on and benefits gained from a service delivery model integrating health education and patient empowerment in a primary care setting. PRACTICE IMPLICATION: Findings from this study shed light on strategies to improve the PEP design in order to meet the needs of individuals with different health-related profiles.

Palliative treatments for patients with inoperable gastroesophageal cancers.

Most patients with cancers of the stomach, oesophagus or gastroesophageal junction ultimately develop metastatic or inoperable disease, rendering them incurable. They can, however, benefit from a variety of palliative interventions involving the multidisciplinary team, including chemotherapy, radiotherapy, endoluminal stenting, laser, or surgery. Often a combination of such strategies will be used to control symptoms, and maintain or improve quality of life. In this article, we review these multidisciplinary interventional approaches in patients with gastroesophageal cancers, and highlight future trends.