Pregnancy related complications in women with hypertrophic cardiomyopathy: a nationwide population-based cohort study.

BACKGROUND: The impact of hypertrophic cardiomyopathy (HCM) on cardiovascular and obstetrical outcomes in pregnant women remains unclear, particularly in Asian populations. This study aimed to evaluate the maternal cardiovascular and obstetrical outcomes in Korean women with HCM. METHODS: Using data from the Korean National Health Insurance Service database, we identified women who gave birth via cesarean section or vaginal delivery after being diagnosed with HCM between 2006 and 2019. Maternal cardiovascular and obstetrical outcomes were assessed based on the trimester of pregnancy. RESULTS: This study included 122 women and 158 pregnancies. No maternal deaths were noted; however, 21 cardiovascular events, such as hospital admission for cardiac problems, including heart failure and atrial fibrillation (AF), new-onset AF or ventricular tachycardia (VT) occurred in 14 pregnancies (8.8%). Cardiac events occurred throughout pregnancy with a higher occurrence in the third trimester. Cesarean sections were performed in 49.3% of the cases, and all cardiovascular outcomes occurring after delivery were observed in patients who had undergone cesarean sections. Seven cases involved preterm delivery, and two of these cases were accompanied by cardiac events, specifically AF. Pre-existing arrhythmia (AF: odds ratio (OR): 7.44, 95% confidence interval (CI): 2.61-21.21, P < 0.001; VT: OR: 31.61, 95% CI: 5.85-172.77, P < 0.001) was identified as a predictor for composite outcomes of cardiovascular events or preterm delivery. CONCLUSIONS: Most pregnant women with HCM were well-tolerated. However, cardiovascular complications could occur in some patients. Therefore, planned delivery may be necessary for selected patients, especially the women with pre-existing arrhythmias.

Effects of exercise during active surveillance for prostate cancer: A systematic review and meta-analysis.

PURPOSE: The efficacy of exercise in men with prostate cancer (PCa) on active surveillance (AS) remains unclear. In this meta-analysis, we aimed to examine the effects of exercise in PCa patients on AS. METHODS: A literature search was conducted in PubMed, EMBASE, and the Cochrane Library using search terms, including exercise, PCa, AS, and randomized controlled trials (RCTs). The means and standard deviations for peak oxygen consumption (VO2peak), prostate-specific antigen (PSA) levels, and quality of life (QoL) were extracted for the intervention and control groups. A random-effects model was used to summarize the effects of exercise. RESULTS: Of the 158 identified studies, six RCTs with 332 patients were included. The interventions included lifestyle modifications (aerobic exercise + diet) in three studies and different exercise modalities in three studies. The intervention duration was 2-12 months; three interventions were supervised and three were self-directed. The pooled weighted mean difference between exercise and usual care for VO2peak was 1.42 mL/kg/min (95% confidence interval [CI]: 0.30 to 2.54, P ≤ 0.001). A non-significant effect was observed for QoL (pooled standardized mean difference [SMD]: 0.24, 95% CI: - 0.03 to 0.51, P = 0.08) which became statistically significant and stronger after excluding one outlier study (P < 0.001). Exercise also had a positive effect on PSA levels (pooled SMD: - 0.43, 95% CI: - 0.87 to 0.01, P = 0.05). CONCLUSION: Exercise improves cardiorespiratory fitness and may improve QoL and PSA levels in men with PCa on AS. Further studies with larger sample sizes are warranted to obtain more reliable results.

Automated Detection of Maxillary Sinus Opacifications Compatible with Sinusitis from CT Images.

BACKGROUND: Sinusitis is a commonly encountered clinical condition that imposes a considerable burden on the healthcare systems. A significant number of maxillary sinus opacifications are diagnosed as sinusitis, often overlooking the precise differentiation between cystic formations and inflammatory sinusitis, resulting in inappropriate clinical treatment. This study aims to improve diagnostic accuracy by investigating the feasibility of differentiating maxillary sinusitis, retention cysts, and normal sinuses. METHODS: We developed a deep learning-based automatic detection model to diagnose maxillary sinusitis using ostiomeatal unit computed tomography images. Of the 1080 randomly selected coronal-view CT images, including 2158 maxillary sinuses, datasets of maxillary sinus lesions comprised 1138 normal sinuses, 366 cysts, and 654 sinusitis based on radiographic findings, and were divided into training (n = 648 CT images), validation (n = 216), and test (n = 216) sets. We utilized a You Only Look Once based model for object detection, enhanced by the transfer learning method. To address the insufficiency of training data, various data augmentation techniques were adopted, thereby improving the model's robustness. RESULTS: The trained You Only Look Once version 8 nano (YOLOv8n) model achieved an overall precision of 97.1%, with the following class precisions on the test set: normal = 96.9%, cyst = 95.2%, and sinusitis = 99.2%. With an average F1 score of 95.4%, the F1 score was the highest for normal, then sinusitis, and finally, cysts. Upon evaluating a performance on difficulty level, the precision decreased to 92.4% on challenging test dataset. CONCLUSIONS: The developed model is feasible for assisting clinicians in screening maxillary sinusitis lesions.

Exercise as Medicine in Cardio-Oncology: Reducing Health Disparities in Hispanic and Latina Breast Cancer Survivors.

PURPOSE OF REVIEW: This review aims to access the current state of the evidence in exercise as medicine for cardio-oncology in Hispanic and Latina breast cancer survivors and to provide our preliminary data on the effects of supervised aerobic and resistance training on cardiovascular disease (CVD) risk in this population. RECENT FINDINGS: Breast cancer survivors have a higher risk of CVD; particularly Hispanic and Latina breast cancer survivors have a higher burden than their White counterparts. Exercise has been shown to reduce CVD risk in breast cancer survivors; however, evidence in Hispanic and Latina breast cancer survivors is scarce. Our review highlights a clear need for exercise oncology clinical trials in Hispanic and Latina breast cancer survivors targeting CVD risk factors. Moreover, our exploratory results highlight that 16 weeks of aerobic and resistance training may reduce the 10-year risk of developing CVD by 15% in Hispanic and Latina breast cancer survivors.

CMOS Detector Staggered Array Module for Sub-Terahertz Imaging on Conveyor Belt System.

A complementary metal-oxide-semiconductor (CMOS) detector array is proposed to improve the sub-terahertz imaging resolution for objects in the conveyor belt system. The image resolution is limited to the implemented configuration, such as the wide spacing in the detector array, the high conveyor belt speed, and the slow response of the signal conditioning block. The proposed array can improve the image resolution in the direction perpendicular to the movement of the belt, which is determined by the size and interval of the detector pixel, by configuring the array into two replaceable columns located at the misaligned horizontal positions. Replaceable detector unit pixels are individually attached to the motherboard after measuring and evaluating the detection performance to construct the proposed array. The intensities of 32 detector pixels placed under the conveyor belt with a width of 160 mm were initially calibrated in every image, including the beam pattern of 0.2 THz signals generated from the gyrotron. The image resolution of the perpendicular direction obtained from the proposed array was measured to be approximately 5 mm at a conveyor belt speed of 16 mm/s, demonstrating a 200% improvement in resolution compared to the conventional linear array under the same conditions.

A Randomized Trial of the Effects of Exercise on Anxiety, Fear of Cancer Progression and Quality of Life in Prostate Cancer Patients on Active Surveillance.

PURPOSE: We examined the effects of exercise on prostate cancer-specific anxiety, fear of cancer progression, quality of life and psychosocial outcomes in patients with prostate cancer on active surveillance. MATERIALS AND METHODS: The ERASE (Exercise during Active Surveillance for Prostate Cancer) Trial randomized 52 patients with prostate cancer undergoing active surveillance to high-intensity interval training (HIIT, 26 patients) or usual care (UC, 26 patients). The HIIT group performed a 12-week, thrice weekly, supervised, aerobic HIIT program. The UC group did not exercise. Patient-reported outcomes were assessed at baseline and after intervention, including prostate cancer-specific anxiety (Memorial Anxiety Scale for Prostate Cancer), fear of cancer progression (Fear of Cancer Recurrence Inventory), prostate cancer symptoms (Expanded Prostate Cancer Index Composite), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core) and psychological health outcomes (eg fatigue, stress and self-esteem). Analysis of covariance was used to compare between-group differences. RESULTS: Fifty of 52 participants (96%) completed patient-reported outcome assessments at 12 weeks. Adherence to HIIT was 96%. Compared to UC, HIIT significantly improved total prostate cancer-specific anxiety (adjusted between-group mean difference -2.7, 95% confidence interval, range -5.0 to -0.4, p=0.024), as well as the fear of progression subscale (p=0.013), hormonal symptoms (p=0.005), perceived stress (p=0.037), fatigue (p=0.029) and self-esteem (p=0.007). CONCLUSIONS: A 12-week supervised HIIT program may improve prostate cancer-specific anxiety, fear of cancer progression, hormone symptoms, stress, fatigue and self-esteem in men with prostate cancer on active surveillance. Larger trials are needed to confirm the effects of HIIT on patient-reported outcomes in the active surveillance setting.

Effects of supervised high-intensity interval training on motivational outcomes in men with prostate cancer undergoing active surveillance: results from a randomized controlled trial.

BACKGROUND: Understanding the motivational effects of supervised aerobic high-intensity interval training (HIIT) may help men with prostate cancer undergoing active surveillance initiate and maintain exercise behavior, however, few studies have addressed this question. This report explored exercise motivation in men with prostate cancer undergoing active surveillance participating in a randomized exercise trial. METHODS: The Exercise during Active Surveillance for Prostate Cancer (ERASE) trial randomized 52 men with prostate cancer on active surveillance to the HIIT exercise group or the usual care (UC) group. The exercise program was supervised aerobic HIIT conducted three times per week for 12 weeks. The motivation questions were developed using the Theory of Planned Behavior and included motivational constructs, anticipated and experienced outcomes, and barriers to HIIT during active surveillance. RESULTS: The HIIT group attended 96% of the planned exercise sessions with 100% compliance to the exercise protocol. Motivation outcome data were obtained in 25/26 (96%) participants in the HIIT group and 25/26 (96%) participants in the UC group. At baseline, study participants were generally motivated to perform HIIT. After the intervention, the HIIT group reported that HIIT was even more enjoyable (p < 0.001; d = 1.38), more motivating (p = 0.001; d = 0.89), more controllable (p < 0.001; d = 0.85), and instilled more confidence (p = 0.004; d = 0.66) than they had anticipated. Moreover, compared to UC, HIIT participants reported significantly higher perceived control (p = 0.006; d = 0.68) and a more specific plan (p = 0.032; d = 0.67) for performing HIIT over the next 6 months. No significant differences were found in anticipated versus experienced outcomes. Exercise barriers were minimal, however, the most often reported barriers included pain or soreness (56%), traveling to the fitness center (40%), and being too busy and having limited time (36%). CONCLUSION: Men with prostate cancer on active surveillance were largely motivated and expected significant benefits from a supervised HIIT program. Moreover, the men assigned to the HIIT program experienced few barriers and achieved high adherence, which further improved their motivation. Future research is needed to understand long-term exercise motivation and behavior change in this setting. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03203460 . Registered on June 29, 2017.

Interventions to Reduce Sedentary Behavior in Cancer Patients and Survivors: a Systematic Review.

PURPOSE OF REVIEW: Sedentary behaviors (SB) after cancer diagnosis are associated with poor prognosis for certain cancers, and cancer patients and survivors report high levels of SB. Reducing SB may be a feasible and effective intervention strategy to improve outcomes. This systematic review aims to identify and evaluate the literature on interventions to reduce SB in cancer patients and survivors. RECENT FINDINGS: Studies were identified via database searches in December 2020. Two authors evaluated study eligibility. Data were extracted and checked, and risk of bias was assessed by the study team. Of 1401 records identified, nine studies involving 394 cancer patients or survivors were included in this review. Six were randomized trials, three were non-randomized intervention studies, and almost all (n = 8) focused on feasibility with small sample sizes. All studies were conducted within the previous 5 years in Canada, Australia, USA, and South Korea. Cancer types studied were breast (n = 3), prostate (n = 2), colorectal or peritoneal (n = 1), and mixed types (n = 3). Intervention duration of 12 weeks was most common (n = 7). Five studies had multiple intervention components, and six studies included wearable devices to measure and/or prompt behavior change. There was an overall trend where intervention groups reduced SB vs. control groups, often coupled with an increase in moderate-to-vigorous physical activity. This review suggests that there is some promise for intervention strategies to reduce SB in cancer patients and survivors. There is a need for more high-quality randomized controlled trials to understand how to best decrease SB in cancer patients and survivors.

Prevalence and Treatment of Vulvar Cancer From 2014-2018: A Nationwide Population-Based Study in Korea.

BACKGROUND: Vulvar cancer is one of the rare gynecologic malignancies. Despite the recent increasing trend of vulvar cancer in western countries due to the increased infection of human papillomavirus, there has been no study for population-based incidence of vulvar cancer in Korea. We aimed to investigate the prevalence and treatment of vulvar cancer in South Korea between 2014 and 2018. METHODS: Data from patients diagnosed and treated with vulvar cancer between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (National In-Patient Sample) in South Korea. RESULTS: A total of 4,636,542 women were identified through the HIRA-NIS database from 2014 to 2018, of which 259 patients were diagnosed and treated for vulvar cancer. The mean age diagnosed with vulvar cancer was 62.82 (± 14.30) years in 2014, 64.19 (± 16.79) years in 2015, and 67.40 (± 14.41) years in 2016. In terms of treatment modalities, the most frequent treatment was surgery only without chemotherapy or radiation therapy. In the age-specific prevalence analysis, vulvar cancer was the most prevalent among those over 70 years old. According to multiple regression analysis, patients' age was significantly associated with the prevalence of vulvar cancer. Vulvar cancer was more prevalent in women with low socioeconomic status (SES) compared to those with high SES in 2018 (OR, 4.242; P < 0.001). CONCLUSION: Considering the high prevalence of vulvar cancer in the elderly, it is necessary to establish a new strategy for early screening and treatment.

Experimental Validation of High Precision Web Handling for a Two-Actuator-Based Roll-to-Roll System.

In this paper, experimental validation of high precision web handling for a two-actuator-based roll-to-roll (R2R) system is presented. To achieve this, the tension control loop is utilized to regulate the tension in the unwinder module, and the velocity loop is utilized to regulate the web speed in the rewinder module owing to the limitation of the number of actuators. Moreover, the radius estimation algorithm is applied to achieve an accurate web speed and the control sequence of the web handling in the longitudinal axis is developed to manipulate the web handling for convenience. Having these, the tension control performances are validated within ±0.79, ±1.32 and ±1.58 percent tension tracking error and 1.6, 1.53 and 1.33 percent web speed error at the speeds of 0.1 m/s, 0.2 m/s, and 0.3 m/s, respectively. The tension control performance is verified within ±0.3 N tracking error in the changes of the reference tension profile at 0.1 m/s web speed. Lastly, the air floating roller is used to minimize the friction terms and the inertia of the idle roller in the tension zone so that tension control performance can be better achieved during web transportation.

Exercise and health-related fitness predictors of chemotherapy completion in breast cancer patients: pooled analysis of two multicenter trials.

PURPOSE: Achieving a higher chemotherapy completion rate is associated with better outcomes in breast cancer patients. We examined the role of exercise and health-related fitness variables in predicting chemotherapy completion in early stage breast cancer patients. METHODS: We pooled data from two large, multicenter, exercise trials that obtained baseline (pre-chemotherapy) measures of exercise and health-related fitness in 543 breast cancer patients initiating adjuvant chemotherapy. Assessments included body composition, cardiovascular fitness, muscular strength, patient-reported physical functioning, and self-reported exercise behavior. Chemotherapy completion was assessed as the average relative dose intensity (RDI) for the originally planned regimen. We used logistic regression analyses with a two-sided p value of < 0.05 to estimate the associations between the predictors and an RDI of ≥ 85%. RESULTS: Overall, 432 of 543 (79.6%) breast cancer patients received an RDI of ≥ 85%. In logistic regression analyses adjusted for significant covariates, patients in the highest 20% vs. lowest 80% of absolute VO2peak were significantly more likely to complete ≥ 85% RDI (89.0% vs. 77.2%; ORadj 2.06, 95% CI 1.07-3.96, p = 0.031). Moreover, patients in the highest 80% vs. lowest 20% of absolute chest strength were significantly more likely to complete ≥ 85% RDI (81.5% vs. 71.4%; ORadj 1.80, 95% CI 1.09-2.98, p = 0.021). CONCLUSIONS: In these exploratory analyses, higher baseline (pre-chemotherapy) cardiovascular fitness and muscular strength were associated with higher rates of chemotherapy completion in early stage breast cancer patients. Aerobic and/or strength training interventions that increase cardiovascular fitness and muscular strength prior to chemotherapy for breast cancer may improve treatment tolerability and outcomes. CLINICAL TRIAL REGISTRATION: START: NCT00115713, June 24, 2005; CARE: NCT00249015, November 7, 2005 ( http://clinicaltrials.gov ).

Associations of health inequality factors with physical activity and sedentary behaviors in Korean cancer survivors.

BACKGROUND: Although physical activity (PA) benefits cancer survivors physically and psychosocially, health inequality may limit these benefits in a subset of cancer survivors, and its association with PA in cancer survivors has not been investigated. Therefore, the purpose of this study is to explore PA levels with regard to health inequality factors (i.e., demographic and socioeconomic profiles) in Korean cancer survivors using the Korean National Health and Nutrition Examination Survey (KNHANES). METHODS: Data of 900 cancer survivors from the KNHANES in 2014-2017 were used. ANCOVA was used to determine differences in PA and sedentary behavior by healthy inequality factors. Logistic regression was used to estimate the associations of the health inequality factors with meeting the aerobic PA guidelines. RESULTS: Higher PA was reported in participants who were male (p = 0.004), younger (p = 0.006), and with higher education (p = 0.003). In adjusted logistic regression models, females were 37% less likely to meet the guideline compared to males (p = 0.045). Participants who were ≥ 70 years were 78% less likely to meet the guideline compared to < 50 years (p < 0.001). Compared to participants who graduated from college/university, participants who graduated from high-, middle-, or elementary-school were 50% (p = 0.005), 53% (p = 0.023), and 71% (p < 0.001) less likely to meet the guideline, respectively. CONCLUSIONS: Lower PA was prevalent in cancer survivors who were female, older, and less educated. Systematic efforts to promote PA are required for targeted cancer subgroups.

Intensity- and domain-specific physical activity levels between cancer survivors and non-cancer diagnosis individuals: a propensity score matching analysis.

PURPOSE: To examine intensity- and domain-specific physical activity (PA) levels between Korean cancer survivors compared with non-cancer individuals. METHODS: We used data from the 2014-2016 Korean National Health and Nutrition Examination Survey (KNHNES) to compare PA levels between 639 cancer survivors and 15,352 non-cancer individuals. Using the 1:5 propensity score matching analysis by sex, age, body mass index (BMI), and education level, 3195 non-cancer individuals were selected. Global Physical Activity Questionnaire (GPAQ) was used to assess PA levels. RESULTS: Cancer survivors were more likely to participate in a leisure-time PA (64.5 ± 157.9 vs. 51.8 ± 145.3 min/week, p < 0.002) compared with non-cancer individuals, while no difference was observed between groups in work and transportation. Cancer survivors undergoing treatment participated in more leisure-time PA (80.9 ± 169.2 vs. 56.6 ± 151.8 min/week, p < 0.02) compared with cancer survivors who completed cancer treatment. However, we found no significant difference in vigorous-intensity PA (18.8 ± 113.9 vs. 20.5 ± 156.1 min/week, p = 0.56) and moderate-intensity PA (186.2 ± 313.1 vs. 203.1 ± 355.3 min/week, p = 0.17) levels between cancer survivors and non-cancer individuals. CONCLUSIONS: This study showed that cancer survivors were more participated in leisure-time PA compared with age, gender, BMI, and education levels matched non-cancer individuals.

Associations between mandibular torus and types of temporomandibular disorders, and the clinical usefulness of temporary splint for checking bruxism.

BACKGROUND: Occlusal stress from oral parafunctional habits is one of the causes of temporomandibular disorders (TMD) and mandibular torus (MT). Although some studies have investigated the correlation between TMD and MT, understanding of the relationships between types of TMD and MT is insufficient. Therefore, we conducted this study to investigate the associations between presence of MT and TMD types. METHODS: This study included 77 patients diagnosed with TMD who first visited our clinic for TMD between March 2019 and July 2020. Among them, 30 (38.9%) had MT, and 54 (70.1%) had oral parafunction. Parafunctional activity during sleep was confirmed using a temporary splint for checking bruxism (TSCB). RESULTS: The relationship between prevalence of MT and oral parafunction in TMD patients was not statistically significant (P = 0.131), but the odds ratio was relatively high at 2.267. An analysis of TMD type revealed that Type I, which is classified as myalgia of the masticatory muscles, and MT had a significant association (P = 0.011). We fabricated a TSCB for 27 patients to wear during sleep and confirmed that 23 (85.2%) had nocturnal bruxism. The TSCB results and presence of MT showed a significant relationship (P = 0.047). CONCLUSION: Through the results of this study, clinicians may consider the hyperactivity of masticatory muscles in the presence of MT when treating TMD patients. In addition, TSCB has a great diagnostic value as it can be easily manufactured and be useful for discovering pre-existing oral parafunctions that patients are not aware of.

Effects of exercise dose and type during breast cancer chemotherapy on longer-term patient-reported outcomes and health-related fitness: A randomized controlled trial.

The Combined Aerobic and Resistance Exercise (CARE) Trial compared different types and doses of exercise performed during breast cancer chemotherapy. Here, we report the longer-term follow-up of patient-reported outcomes, health-related fitness and exercise behavior at 6, 12 and 24 months postintervention. A multicenter trial in Canada randomized 301 breast cancer patients initiating chemotherapy to thrice weekly, supervised exercise consisting of a standard dose of 25-30 min of aerobic exercise (STAN; n = 96), a higher dose of 50-60 min of aerobic exercise (HIGH; n = 101) or a combined dose of 50-60 min of aerobic and resistance exercise (COMB; n = 104) performed for the duration of chemotherapy (median of 17 weeks). Primary outcomes were patient-reported outcomes including quality of life, cancer-related symptoms and psychosocial outcomes. Secondary outcomes were objective health-related fitness (assessed at 12 months only) and self-reported exercise behavior. A total of 269 (89.4%) participants completed patient-reported outcomes at all three follow-up time points and 263 (87.4%) completed the health-related fitness assessment at 12-month follow-up. COMB was significantly superior to (i) STAN for sleep quality at 6-month follow-up (p = 0.027); (ii) HIGH for upper body muscular endurance at 12-month follow-up (p = 0.020); and (iii) HIGH for meeting the resistance exercise guideline at 6-month follow-up (p = 0.006). Moreover, self-reported meeting of the combined exercise guideline during follow-up was significantly associated with better patient-reported outcomes and health-related fitness. Performing combined exercise during and after breast cancer chemotherapy may result in better longer-term patient-reported outcomes and health-related fitness compared to performing aerobic exercise alone.

Patterns and predictors of exercise behavior during 24 months of follow-up after a supervised exercise program during breast cancer chemotherapy.

BACKGROUND: Understanding the longer-term exercise behavior of patients with breast cancer after chemotherapy is important to promote sustained exercise. The purpose of the current study was to report the longer-term patterns and predictors of exercise behavior in patients with breast cancer who exercised during chemotherapy. METHODS: In the Combined Aerobic and Resistance Exercise (CARE) Trial, 301 patients with breast cancer were randomized to three different exercise prescriptions during chemotherapy. Exercise behaviors after chemotherapy were self-reported at 6-, 12-, and 24-month follow-up. Exercise patterns were identified by categorizing patients according to which exercise guideline they were meeting (neither, aerobic only, resistance only, or combined) at each of the three follow-up timepoints (64 possible patterns). Predictors of longer-term exercise behavior included physical fitness, patient-reported outcomes, and motivational variables from the theory of planned behavior assessed at postintervention (postchemotherapy). Univariate and multivariate stepwise multinomial logistic regression and linear regression were used for statistical analyses. RESULTS: A total of 264 (88%) participants completed all three follow-up exercise behavior assessments and exhibited 50 different exercise patterns. Postintervention aerobic fitness was the most consistent predictor of longer-term exercise behavior at all three timepoints. For example, higher aerobic fitness (per 1 ml/kg/min) predicted better adherence to the "aerobic only" (OR = 1.09; p = 0.005) and "combined" (OR = 1.12; p < 0.001) guidelines compared to "neither" guideline at 6-month follow-up. Additionally, higher postintervention muscular strength (per 1 kg) was associated with better adherence to the "resistance only" (OR = 1.07; p = 0.025) and "combined" (OR = 1.08; p < 0.001) guidelines compared to "neither" guideline at 24-month follow-up. Finally, lower perceived difficulty (per 1 scale point) was associated with better adherence to the "combined" (OR = 0.62; p = 0.010) and "aerobic only" (OR = 0.58; p = 0.002) guideline compared to the "neither" guideline at the 24-month follow-up. CONCLUSIONS: Our study is the first to show that the longer-term exercise patterns of patients with breast cancer who exercised during chemotherapy are diverse and predicted by physical fitness and motivational variables after chemotherapy. Our novel implications are that improving physical fitness during chemotherapy and applying motivational counseling after chemotherapy may improve longer-term exercise behavior in patients with breast cancer. TRIAL REGISTRATION: (NCT00249015).

Development process of an evidence-based exercise program for post-operative colorectal cancer patients.

PURPOSE: Exercise is generally accepted to be beneficial for colorectal cancer patients; however, very few studies have investigated the effects of exercise on patient care and health outcomes during the immediate post-operative recovery period. Furthermore, very few studies have investigated the safety, feasibility, and efficacy of exercise on post-operative cancer patients. Although intervention programs should be based on solid evidence from clinical trials, the majority of previous studies have not presented the development process of the intervention programs. This paper describes a ten-step development process of an inpatient exercise program for colorectal cancer patients after colectomy. METHODS: The development process is composed of the following ten steps: systematic literature review, understanding patient characteristics via patient survey, first expert group discussion, development of the first draft exercise program, pretest, focus group interview, second expert group discussion, pilot study, randomized controlled trial, and the final exercise program development. RESULTS: The exercise program developed through the ten-step process was divided into three phases according to the patients' condition. For all three phases, patients performed the exercises two times a day, once under supervision. Any specific exercises that caused pain on a given day were excluded from the exercise program for that day. The exercise program reduced the length of hospital stay and time to flatus in colorectal cancer patients after surgery. CONCLUSION: This study reports a safe and effective means to develop an evidence-based exercise program not only for colorectal cancer patients but also for other population groups.

Content-Aware Eye Tracking for Autostereoscopic 3D Display.

This study develops an eye tracking method for autostereoscopic three-dimensional (3D) display systems for use in various environments. The eye tracking-based autostereoscopic 3D display provides low crosstalk and high-resolution 3D image experience seamlessly without 3D eyeglasses by overcoming the viewing position restriction. However, accurate and fast eye position detection and tracking are still challenging, owing to the various light conditions, camera control, thick eyeglasses, eyeglass sunlight reflection, and limited system resources. This study presents a robust, automated algorithm and relevant systems for accurate and fast detection and tracking of eye pupil centers in 3D with a single visual camera and near-infrared (NIR) light emitting diodes (LEDs). Our proposed eye tracker consists of eye-nose detection, eye-nose shape keypoint alignment, a tracker checker, and tracking with NIR LED on/off control. Eye-nose detection generates facial subregion boxes, including the eyes and nose, which utilize an Error-Based Learning (EBL) method for the selection of the best learnt database (DB). After detection, the eye-nose shape alignment is processed by the Supervised Descent Method (SDM) with Scale-invariant Feature Transform (SIFT). The aligner is content-aware in the sense that corresponding designated aligners are applied based on image content classification, such as the various light conditions and wearing eyeglasses. The conducted experiments on real image DBs yield promising eye detection and tracking outcomes, even in the presence of challenging conditions.

A Secure and Lightweight Three-Factor-Based Authentication Scheme for Smart Healthcare Systems.

Internet of Things (IoT) technology has recently been integrated with various healthcare devices to monitor patients' health status and share it with their healthcare practitioners. Since healthcare data often contain personal and sensitive information, healthcare systems must provide a secure user authentication scheme. Recently, Adavoudi-Jolfaei et al. and Sharma and Kalra proposed a lightweight protocol using hash function encryption only for user authentication on wireless sensor systems. In this paper, we found some weaknesses in target schemes. We propose a novel three-factor lightweight user authentication scheme that addresses these weaknesses and verifies the security of the proposed scheme using a formal verification tool called ProVerif. In addition, our proposed scheme outperforms other proposed symmetric encryption-based schemes or elliptic curve-based schemes.

Sphere-to-Multipod Transmorphic Change of Nanoconfined Pt Electrocatalyst during Oxygen Reduction Reaction.

An oxygen reduction reaction (ORR) catalyst/support system is designed to have Pt nanoparticles nanoconfined in a nanodimensionally limited space. Holey crumpled reduced graphene oxide plates (hCR-rGO) are used as a carbon support for Pt loading. As expected from interparticular Pt-to-Pt distance of Pt-loaded hCR-rGO longer than that of Pt/C (Pt-loaded carbon black as a practical Pt catalyst), the durability of ORR electroactivity along cycles is improved by replacing the widely used carbon black with hCR-rGO. Unexpected morphological changes of Pt are electrochemically induced during repeated ORR processes. Spherical multifaceted Pt particles are evolved to {110}-dominant dendritic multipods. Nanoconfinement of a limited number of Pt within a nanodimensionally limited space is responsible for the morphological changes. The improved durability observed from Pt-loaded hCR-rGO originates from 1) dendritic pod structure of Pt exposing more active sites to reactants and 2) highly ORR-active Pt {110} planes dominant on the surface.