Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis.

PURPOSE: This study aims to summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind-body exercises on symptoms and quality of life (QOL) in cancer survivors. METHODS: A systematic search in four electronic databases targeted randomized and non-randomized clinical studies evaluating TCQ for fatigue, sleep difficulty, depression, pain, and QOL in cancer patients, published through August 2016. Meta-analysis was used to estimate effect sizes (ES, Hedges' g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed. RESULTS: Our search identified 22 studies, including 15 RCTs that evaluated 1283 participants in total, 75% women. RCTs evaluated breast (n = 7), prostate (n = 2), lymphoma (n = 1), lung (n = 1), or combined (n = 4) cancers. RCT comparison groups included active intervention (n = 7), usual care (n = 5), or both (n = 3). Duration of TCQ training ranged from 3 to 12 weeks. Methodological bias was low in 12 studies and high in 3 studies. TCQ was associated with significant improvement in fatigue (ES = - 0.53, p < 0.001), sleep difficulty (ES = - 0.49, p = 0.018), depression (ES = - 0.27, p = 0.001), and overall QOL (ES = 0.33, p = 0.004); a statistically non-significant trend was observed for pain (ES = - 0.38, p = 0.136). Random effects models were used for meta-analysis based on Q test and I 2 criteria. Funnel plots suggest some degree of publication bias. Findings in non-randomized studies largely paralleled meta-analysis results. CONCLUSIONS: Larger and methodologically sound trials with longer follow-up periods and appropriate comparison groups are needed before definitive conclusions can be drawn, and cancer- and symptom-specific recommendations can be made. IMPLICATIONS FOR CANCER SURVIVORS: TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.

The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis.

PURPOSE: To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD). METHODS: A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters. RESULTS: Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I2 indicated limited heterogeneity. Funnel plots suggested some degree of publication bias. CONCLUSION: Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.

[Effects of functional electrical stimulation based on normal gait pattern on walking function in subjects with recovery of stroke].

OBJECTIVE: To observe the effects of functional electrical stimulation(FES) based on normal gait pattern on walking function in subjects with recovery of stroke. METHODS: From December 2010 to January 2013, 58 patients with recovery of stroke were recruited from the Rehabilitation Medicine Departments of Sun Yat-sen Memorial Hospital and the Guangdong Provincial Traditional Chinese Medicine Hospital. And the Minimize software was used to divide them randomly into 1 of the 3 groups: four-channel FES group (n=29), single-channel FES group (n=15) and placebo electrical group (n=14) at the rate of 2∶1∶1. All received standardized rehabilitation program. The four-channel FES group received four-channel FES treatment based on normal gait pattern, the single-channel FES group received single-channel FES treatment, the placebo electrical group received the same electrical stimulation as the four-channel FES group, but without current output when stimulating. Stimulation lasted for 30 min/d, 1 session / d, 5 d/w for 3 weeks. All subjects in the three groups received Fugl-Meyer Assessment scale (FMA), Berg Balance scale (BBS), gait speed during a 10-meter walking test, muscle co-activation index (CI) of the lower extremity during walking and the Modified Barthel index (MBI) assessments before and after 3 weeks treatment. RESULTS: Before treatment, the FMA, BBS and gait speed during a 10-meter walking test of the four-channel FES group were (23.0±2.2), (31±71) and (0.23±0.10), respectively. After 3 weeks treatment, the scores were improved to (28.4±1.5), (42±6)and(0.43±0.09), respectively. And the FMA, BBS and gait speed during a 10-meter walking test of the ingle-channel FES group increased from (21.9±3.4), (31±6) and (0.24±0.09) to (26.6±1.8), (38±5) and (0.34±0.08), respectively. The placebo electrical group increased from (23.6±3.0), (33±5) and (0.25±0.09) respectively to (26.0±2.4), (36±4) and (0.29±0.08). And the FMA, BBS and gait speed during a 10-meter walking test of the three groups were significantly higher than those in pre-treatment (P<0.05), and the scores in four-channel FES group were significantly higher than the single-channel group and the placebo electrical group's (P<0.05). The MBI score of the three groups were all improved, but it didn't show difference among the three groups (P>0.05). The results of surface electromyography showed significant decrease in CI of quadriceps / hamstring of the 3 groups, and the four-channel FES group had more significant decrease than the other two groups (P<0.05). CONCLUSION: Functional electrical stimulation based on normal gait pattern could improve walking function in subjects with recovery of stroke.

Effects of feeding diets containing highly peroxidized distillers dried grains with solubles and increasing vitamin E levels to wean-finish pigs on growth performance, carcass characteristics, and pork fat composition.

Lipid peroxidation in animal feed can negatively affect growth performance and meat quality. Weanling pigs (n = 432; BW = 6.6 ± 0.4 kg) were used to evaluate the effects of feeding peroxidized distillers dried grains with solubles (DDGS) with 3 levels of vitamin E (α-tocopheryl acetate) on growth performance, carcass composition, fatty acid composition of pork fat, and lipid peroxidation in LM. The DDGS source used in this study contained the highest thiobarbituric acid reactive substances (TBARS) value, peroxide value, and total S content (5.2 ng malondialdehyde/mg oil, 84.1 mEq/kg oil, and 0.95%, respectively) among 30 DDGS sources sampled. Pens within blocks were assigned randomly to 1 of 6 diets in a 2 × 3 factorial arrangement of treatments with 8 pens per treatment and 9 pigs per pen. Pigs were fed a corn-soybean meal (CON) or 30% peroxidized DDGS (Ox-DDGS) diets with 3 levels of vitamin E: none supplemented (No-E), NRC (1X-E), or 10X NRC (10X-E). Compared to CON, inclusion of 30% Ox-DDGS in diets reduced (P < 0.001) final BW (110 vs. 107 kg), overall ADG (0.76 vs. 0.74 kg/d), and G:F (0.39 vs. 0.37). Increasing dietary vitamin E concentrations improved G:F (P = 0.03) of pigs fed 10X-E and 1X-E vs. No-E diets (0.39 and 0.39 vs. 0.38, respectively). Hot carcass weight, dressing percentage, backfat depth, and LM area were reduced (P < 0.01) in pigs fed Ox-DDGS compared to CON, but percentage of fat-free carcass lean was not affected. Feeding Ox-DDGS increased (P < 0.001) PUFA concentration, particularly linoleic acid (P < 0.001), and iodine value (P < 0.001) in belly fat and backfat compared to pigs fed CON. Dietary vitamin E levels did not affect fatty acid profiles in belly or back fat. Loin muscle TBARS were measured to determine the lipid peroxidation level in pork loins. Although pigs were fed a Ox-DDGS source in this study, TBARS in LM were similar between Ox-DDGS and CON treatments. There was no interaction between Ox-DDGS and dietary vitamin E concentration in LM TBARS. Alpha-tocopherol concentration in LM was greater (P < 0.001) in 10X-E than No-E or 1X-E dietary treatments. Compared to CON, feeding Ox-DDGS increased α-tocopherol concentration in LM of pigs fed No-E (1.0 vs. 3.1 mg/kg; P = 0.005) but not in those fed 1X-E or 10X-E. These results indicate that feeding diets containing 30% Ox-DDGS to wean-finish pigs may negatively affect growth performance, but supplementation of additional vitamin E in the diet did not counteract these effects.

High sulfur content in corn dried distillers grains with solubles protects against oxidized lipids by increasing sulfur-containing antioxidants in nursery pigs.

Some sources of corn dried distillers grains with solubles (DDGS) contain relatively high amounts of oxidized lipids produced from PUFA peroxidation during the production process. These oxidized lipids may impair metabolic oxidation status of pigs. The objective of this study was to understand the effects of feeding corn-soybean meal diets (CON) or diets containing 30% highly oxidized DDGS with 1 of 3 levels of supplemental vitamin E (dl-α-tocopheryl acetate), none, the 1998 NRC level (11 IU/kg), and 10x the 1998 NRC level (110 IU/kg), on oxidative status of nursery pigs. The DDGS source used in this study contained the greatest thiobarbituric acid reactive substances (TBARS) value, peroxide value, and total S content (5.2 ng/mg oil, 84.1 mEq/kg oil, and 0.95%, respectively) relative to 30 other DDGS sources sampled (mean values = 1.8 ng/mg oil, 11.5 mEq/kg oil, and 0.50%, respectively). Barrows (n = 54) were housed in pens and fed the experimental diets for 8 wk after weaning and transferred to individual metabolism cages for collection of feces, urine, blood, and liver samples. Total S content was greater in DDGS diets than in CON (0.39 vs. 0.19%). Dietary inclusion of 30% DDGS improved apparent total tract digestibility of S (86.8 vs. 84.6%; P < 0.001) and S retained (2.94 vs. 2.07 g/d; P < 0.01) compared with CON. Although pigs were fed highly oxidized DDGS in this study, serum TBARS were similar between DDGS and CON treatments. There was an interaction between DDGS and dietary vitamin E level for serum concentrations of α-tocopherol. Serum α-tocopherol concentrations were greater (P < 0.001) in pigs fed DDGS diets than those fed CON when dl-α-tocopheryl acetate was not provided or provided at the NRC level but were similar when dl-α-tocopheryl acetate was supplemented at the 10x NRC level. Pigs fed DDGS diets had greater serum concentrations of S-containing AA, particularly Met (P < 0.001) and taurine (P = 0.002), compared with those fed CON. Liver glutathione concentration was greater in pigs fed DDGS diets than CON (56.3 vs. 41.8 nmol/g). Dietary inclusion of DDGS (P < 0.001) and vitamin E (P = 0.03) increased enzyme activity of glutathione peroxidase. The elevated concentrations of S-containing antioxidants (Met, taurine, and glutathione) in vivo may protect pigs against oxidative stress when feeding highly oxidized DDGS. Therefore, the increased S content in DDGS may be beneficial, and increasing concentrations of vitamin E in diets may not be necessary to protect pigs against metabolic oxidative stress when feeding high S and highly peroxidized DDGS.

A profile of the belief system and attitudes to end-of-life decisions of senior clinicians working in a National Health Service Hospital in the United Kingdom.

There is evidence from outside the United Kingdom to show that physicians' religious beliefs influence their decision making at the end of life. This UK study explores the belief system of consultants, nurse key workers and specialist registrars and their attitudes to decisions which commonly must be taken when caring for individuals who are dying. All consultants (N = 119), nurse key workers (N = 36) and specialist registrars (N = 44) working in an acute hospital in the north-east of England were asked to complete a postal questionnaire. In all, 65% of consultants, 67% of nurse key workers and 41% of specialist registrars responded. Results showed that consultants' religion and belief systems differed from those of nurses and the population they served. Consultants and nurses had statistically significant differences in their attitudes to common end of life decisions with consultants more likely to continue hydration and not withdraw treatment. Nurses were more sympathetic to the idea of physician-assisted suicide for unbearable suffering. This study shows the variability in belief system and attitudes to end of life decision making both within and between clinical groups. This may have practical implications for the clinical care given and the place of care. The personal belief system of consultants was not shown to affect their overall attitudes to withdrawing life-sustaining treatment or physician-assisted suicide.

Adaptive hypersensitivity to estrogen: mechanism for superiority of aromatase inhibitors over selective estrogen receptor modulators for breast cancer treatment and prevention.

Clinical observations suggest that human breast tumors can adapt to endocrine therapy by developing hypersensitivity to estradiol (E(2)). To understand the mechanisms responsible, we examined estrogenic stimulation of cell proliferation in a model system and provided in vitro and in vivo evidence that long-term E(2) deprivation (LTED) causes "adaptive hypersensitivity". The enhanced responses to E(2) do not involve mechanisms acting at the level of transcription of estrogen-regulated genes. We found no evidence of hypersensitivity when examining the effects of E(2) on regulation of c-myc, pS2, progesterone receptor, several estrogen receptor (ER) reporter genes, or c-myb in hypersensitive cells. Estrogen deprivation of breast cells long-term does up-regulate both the MAP kinase and phosphatidyl-inositol 3-kinase pathways. As a potential explanation for up-regulation of these signaling pathways, we found that ERalpha is 4- to 10-fold up-regulated and co-opts a classic growth factor pathway using Shc, Grb-2 and Sos. This induces rapid non-genomic effects which are enhanced in LTED cells. E(2) binds to cell membrane-associated ERalpha, physically associates with the adapter protein SHC, and induces its phosphorylation. In turn, Shc binds Grb-2 and Sos, which results in the rapid activation of MAP kinase. These non-genomic effects of E(2) produce biological effects as evidenced by Elk activation and by morphological changes in cell membranes. Further proof of the non-genomic effects of E(2) involved use of cells which selectively expressed ERalpha in the nucleus, cytosol and cell membrane. We created these COS-1 "designer cells" by transfecting ERalpha lacking a nuclear localization signal and containing a membrane localizing signal. The concept of "adaptive hypersensitivity" and the mechanisms responsible for this phenomenon have important clinical implications. Adaptive hypersensitivity would explain the superiority of aromatase inhibitors over the selective ER modulators (SERMs) for treatment of breast cancer. The development of highly potent third-generation aromatase inhibitors allows reduction of breast tissue E2 to very low levels and circumvents the enhanced sensitivity of these cells to the proliferative effects of E(2). Clinical trials in the adjuvant, neoadjuvant and advanced disease settings demonstrate the greater clinical efficacy of the aromatase inhibitors over the SERMs. More recent observations indicate that the aromatase inhibitors are superior for the prevention of breast cancer as well. These observations may be explained by the hypothesis that estrogens induce breast cancer both by stimulating cell proliferation and by their metabolism to genotoxic products. The SERMs block ER-mediated proliferation only, whereas the aromatase inhibitors exert dual effects on proliferation and genotoxic metabolite formation.

Coping of cancer patients during and after radiotherapy--a follow-up of 2 years.

AIM: We wanted to understand coping strategies specific to different phases up to two years after radiotherapy, to identify patients who are at higher risk of mood disturbances and to characterise the association between coping strategies and psychosocial adaptation. PATIENTS AND METHODS: From 1997 to 2001, 2,169 patients with different diagnoses were screened (27.8% refused to participate). Data of 276 patients from the beginning of radiotherapy (ti1) and 5 follow-up investigations (ti6/2 years) could be analysed. With the FKV (Freiburg Questionnaire Coping with Disease) cancer-specific coping aspects were assessed. The association between coping styles and psychosocial adaptation was evaluated using the Questionnaire on Stress in Cancer Patients (QSC) and the questionnaire on Functional Assessment of Cancer Treatment (FACT-G). RESULTS: 'Active problem-orientated' coping and 'distractions' are the most important coping strategies. Only 'active problem-orientated' and 'depressive' coping showed a significant decrease. We observed higher means on the scales of the FKV in women. Marital status (single, married, divorced/widowed) had a significant influence on active problem-orientated coping and spirituality. Age, children, education, T/M status and curative/ palliative intention of treatment had no influence on coping styles. Breast cancer patients and lymphoma patients demonstrated the highest use of coping strategies after radiotherapy with a significant decrease of 'active problem-orientated coping'. Depressive coping and minimizing importance at ti1 were associated with high psychosocial distress and low quality of life (QoL) at ti6. CONCLUSION: The correlation of coping mechanisms at the beginning of radiotherapy with low QoL and high psychosocial stress at 2 years could help to identify patients at risk for low psychosocial adaptation. Psycho-oncologically trained teams of physicians would best correspond to this profile of needs and would contribute significantly to an ameliorated adaptation of patients to cancer which could lead to higher life satisfaction.

[Preventive and therapeutic effect of Chinese herbs naofeikang on experimental emphysema and pulmonary artery hypertension in hamsters].

OBJECTIVE: To observe preventive and therapeutic effect of Chinese herbs Naofeikang on hypoxic pulmonary artery hypertension of elastase-induced emphysema hamsters and investigate its mechanism. METHODS: Hamsters for 30 days after intratracheally-instilled elastase, were kept in hypoxia environment under normal atmospheric pressure for 15 days, 50 hamsters were divided into prevention group (Prv), treatment group (T), emphysema + hypoxia (EH), and control group(N). Mean pulmonary artery pressure (MPAP) was measured before hamsters were killed. And then right ventricle hypertrophy index (RVHI) was measured, as well as circulating endothelial cells (CEC) and cells recoveries from bronchoalveolar lavage fluid (BALF) were counted. Meanwhile, pulmonary tissue changes were studied under light microscope with morphometric analysis. RESULTS: Compared with EH group, MPAP, CEC, and cells recoveries of BALF of Prv and T groups were significantly decreased (P < 0.05 or P < 0.01); Mean linear intercept and percentage of arterial media area of Prv and T groups had totally a significant difference (P < 0.01) in comparison with EH group. CONCLUSIONS: Chinese herbs Naofeikang could lower pulmonary hypertension, preserve vessel endothelial cells and lessen the inflammatory reaction in pulmonary tissue. Thereby, it could hinder the further development of emphysema and inhibit the remodeling of pulmonary small artery.

An experimental study of electro-acupuncture on auditory impairment caused by kanamycin in guinea pigs.

Frequency following response (FFR) and auditory brain stem evoked potential response (ABR) were used to determine the auditory acuity in evaluating the effect of electro-acupuncture treatment of kanamycin-induced auditory impairment in guinea pigs. The succinate dehydrogenase (SDH) activity and morphological changes of the inner ear receptors were examined under the light and scanning electron microscope in cochlear spread preparations. The results showed that 1) electro-acupuncture was effective but no significant differences were found among the stimulating wave forms; 2) Tinggong (SI 19), Yifeng (SJ 17), Shenshu (UB 23), Sanyinjiao (Sp 6), Zhubin (K 9) and Waiguan (SJ 5) are all effective acupoints, especially the combination of Tinggong (SI 19), Sanyinjiao (Sp 6) and Zhubin (K 9) acupoints; 3) improvement in the cochlear function and excitability of the cortical and lower auditory center and increase of the mitochondrial SDH activity and energy supply in hair cells might contribute to the mechanism of the treatment.

[The morphometric analysis of lung on protective effect of Chinese herbs 814 on elastase-induced emphysema in hamsters].

OBJECTIVE: To determine the protective effect of Chinese herbal medicine 814 on elastase-induced emphysema in hamsters. METHODS: Animals were injected intratrachealy with elastase for emphysematous models, prophylactic-therapeutic groups were administrate with 814 through esophagus two weeks before the instillation of elastase untill animals were killed at three different time at first, second, and third month. Pulmonary artery pressure, blood gas analysis, heart index and the ratio of dried weight to wet weight of lungs (WW/DW) were examined. The lung paraffin sections were measured mean linear intercept (MLI), mean alveolar number (MAN), ratio of parenchyma area to total area (PA/TA) by the microscope-computer morphometric analysis system. RESULTS: WW/DW in the prophylactic-therapeutic groups was recovered at the same level with the controls, whereas the emphysematous were significantly increased (P < 0.05); and compared with the emphysematous groups, the prophylactictherapeutic groups significantly decreased in MLI, increased in MAN and PA/TA (P < 0.001 or P < 0.05). CONCLUSIONS: Administration of 814 could partly inhibit the development of emphysema induced by elestase in hamsters.

[Effect of herbs 814 on tumor necrosis factor a production from alveolar macrophages in vitro].

OBJECTIVE: To study the influence of herbs 814 on the secretion of tumor necrosis factor alpha (TNF-alpha) from hamster alveolar macrophages (AMs) in vitro and elucidate mechanism of herbs 814's prevention of emphysema. METHODS: AMs of hamster were collected by bronchial alveolar lavage (BAL). The lung lavage cells were adjusted to 5 x 10(5)/ml and seeded in each well of a 24-well tissue culture plates. The herbs 814 was added into these wells before or after lipopolysaccharide (LPS) stimulation and then cultured supernatants were collected. TNF-alpha production in the supernatants was tested by ELISA, TNF-alpha cytotoxicity was assayed using L929 cells which were susceptible to TNF-alpha and a monoclonal antibody (MAb) that neutralizes rhTNF-alpha was utilized to identify the cytotoxicity of cultured TNF-alpha. RESULTS: ELISA showed that TNF-alpha production in the supernatants with 814 added was lower than those either in LPS-stimulated or non LPS-stimulated supernatants and there was a significant decrease in the supernatants of higher concentration (1:5) of herbs 814. Cytotoxicity test showed that TNF-alpha cytotoxic activity in the supernatants into which herbs 814 was added was lower than one in the LPS-stimulated supernatants and there was a significant decrease in the supernatants of higher concentration (1:5) of herbs 814. Meanwhile, MAb significantly reduced cytotoxicity of LPS-stimulated culture supernatants. CONCLUSIONS: Herbs 814 could inhibit the secretion of TNF-alpha and prevent the lung damage mediated by TNF-alpha.

[Effects of selenium polysaccharide and sodium selenite on blood selenium concentration and liver cytochrome P450 monooxygenase system in rat].

The effects of selenium polysaccharide and sodium selenite administered by single or repetitive intraperitoneal injection (i.p.) on blood selenium concentration, the activities of liver cytochrome P450, b5 as well as NAD(P)H cytochrome C reductase, glutathione S-transferase and glutathione were studied in rats. The biological effects of selenium polysaccharide and sodium selenite were also compared. The results indicated that the blood selenium concentration was increased rapidly and reached the peak in 2 hours followed by gradual decline after selenium polysaccharide and sodium selenite were i.p. injected at a dose of Se 0.6 mg/kg. The absorption and eliminating rates of Se from sodium selenite were faster than that from selenium polysaccharide. Administration of selenium polysaccharide and sodium selenite at a dose of 0.2 mg/kg by i.p. increased the blood selenium concentration to 2.6 and 2.1 times of those of control group, respectively, and the blood selenium concentration of selenium polysaccharide group was significantly higher than that of sodium selenite group (P < 0.05). The activities of liver cytochrome P450, b5 and GST were inhibited by selenium polysaccharide and sodium selenium in vivo and in vitro experiments. Those proteins were decreased to 57%, 70% and 62% of the control, respectively, by selenium polysaccharide which has particularly stronger effects on cytochrome P-450 monooxygenase system (P < 0.05). The two selenium compounds did not appear to affect the activity of NAD(P)H cytochrome C reductase. Both of the selenium polysaccharide and sodium selenite could enhance the activity of glutathion peroxidase significantly (P < 0.05).

[Treatment of ototoxic auditory damage caused by kanamycin with electroacupuncture at different acupoints].

We adopted the technique and method of integrating the morphology with function to select the effective acupoints for treatment of deafness. The results show that: (1) Tinggong (SI 19), Yifeng (TE 17), Waiguan (TE 5), Shenshu (UB 23), Sanyinjiao (SP 6) and Zhubin (KI 9) etc. are the effectine acupoints for the treatment of ototoxic auditory damage caused by drug, especially, the effect of Tinggong, Sanyinjiao and Zhubin etc, is much better; (2) electroacupuncture can promote audibility, improve SDH activity and relieve progressing injury of auditory hair cells, (3) FFR method has an important significance in the determination of ototoxic damage caused by drug.