Combined Ultrahypofractionated Whole-Breast Irradiation and IORT-Boost: A Safety and Feasibility Analysis.

BACKGROUND: The current standard of local treatment for patients with localized breast cancer (BC) includes whole breast irradiation (WBI) after breast-conserving surgery (BCS). Ultrahypofractionated WBI schemes (1-week treatment) were shown not to be inferior to the standard WBI. Tumor bed boost using photon intraoperative radiotherapy (IORT) is safe and feasible in combination with standard WBI. The aim of the present study is to assess, for the first time, the feasibility and safety of combining photon IORT with ultrahypofractionated WBI. METHODS: Patients diagnosed with low-risk early BC candidates for BCS were included in this prospective study. IORT was administered at a dose of 20 Gy to the surface's applicator, and WBI was administered 3-5 weeks after surgery at a total dose of 26 Gy in five consecutive days. RESULTS: From July 2020 to December 2022, seventy-two patients diagnosed with low-risk early BC and treated in our institution were included in this prospective study. All patients completed the proposed treatment, and no severe acute or late grade 3 toxicity was observed 3 and 12 months after WBI, respectively. CONCLUSIONS: Our results confirm for the first time that the combination of ultrafractionation WBI and photon-IORT after BCS is a feasible and safe option in patients with early BC.

Self-diffusion in polycrystalline Li1+x Ti2-x Al x (PO4)3 (0.2 ≤ x ≤ 0.4) samples followed by 7Li PFG (pulse field gradient) NMR spectroscopy.

Short and long range lithium motions in powder Li1+x Ti2-x Al x (PO4)3 (LTAP) NASICON compounds prepared by ceramic (x = 0.2 and 0.4) and sol-gel (x = 0.3 and 0.4) routes are discussed. ND diffraction and MAS-NMR spectroscopy were previously used to investigate structural features of these compounds. In particular, Fourier map differences showed that the amount of Li atoms allocated at M3 increases at the expense of M1 sites when the Li content increases. In this work, PFG-NMR results show that diffusion coefficients rise with the amount of lithium and temperature. The restricted diffusion inside NASICON particles is compared with "free" diffusion processes. At 300 K, diffusion coefficients D PFG ∼ 5 × 10-12 m2 s-1 have been deduced in ceramic x = 0.2 and 0.4 samples, decreasing with diffusion time Δ used in PFG experiments. In sol-gel samples, diffusion coefficients are near those of ceramic samples, but decrease faster with diffusion Δ times, as a consequence of the Li confinement inside sub-micrometric crystallites. The NMR spin-echo signal displays minima at specific q(γgδ) values that are related to the crystallite size. From R dif ∼ q m -1 distances, calculated from the position of minima, and from diffusion coefficients deduced for high Δ values, the mean crystallite size was estimated. Finally, from the temperature dependence of conductivity and diffusion coefficients, the activation energy and charge carriers concentrations were determined.

Intraseason Changes in Vertical Jumps of Male Professional Basketball Players.

This study aimed to analyze basketball players' jumping bhavior in the Squat Jump (SJ), Countermovement Jump (CMJ), and Free Arm Swing CMJ (CMJ Free) during a professional basketball season and check if it is modulated by the players' specific playing position, the time played on court, and the different leagues. Fifty-three male professional basketball players were assessed in three different moments of the season through SJ, CMJ, and CMJ Free. Between the beginning of pre-season (1st assessment) and the second round of the season (3rd assessment), there was a strong increase in performance in the three jumps (SJ Height: 5.6%, η2P = 0.234, p = 0.007; CMJ Height: 5.1%, η2P = 0.177, p = 0.007; CMJ Free height: 4.11%, η2P = 0.142, p = 0.01). There was also a significantly large increase in SJ and CMJ between the 2nd and 3rd assessments and in the CMJ Free between the 1st and 2nd assessments. No significant interactions were found between jumping performance and the group factors (players' specific playing position, time played on court, and league). In conclusion, SJ, CMJ, and CMJ Free performance strongly increases between 1st and 3rd assessment, without being influenced by the specific playing position or the minutes played per game.

Safety and efficacy of intra-arterial bone marrow mononuclear cell transplantation in patients with acute ischaemic stroke in Spain (IBIS trial): a phase 2, randomised, open-label, standard-of-care controlled, multicentre trial.

BACKGROUND: Pilot clinical trials have shown the safety of intra-arterial bone marrow mononuclear cells (BMMNCs) in stroke. However, the efficacy of different doses of intra-arterial BMMNCs in patients with acute stroke has not been tested in a randomised clinical trial. We aimed to show safety and efficacy of two different doses of autologous intra-arterial BMMNC transplantation in patients with acute stroke. METHODS: The IBIS trial was a multicentre phase 2, randomised, controlled, investigator-initiated, assessor-blinded, clinical trial, in four stroke centres in Spain. We included patients (aged 18-80 years) with a non-lacunar, middle cerebral artery ischaemic stroke within 1-7 days from stroke onset and with a National Institutes of Health Stroke Scale score of 6-20. We randomly assigned patients (2:1:1) with a computer-generated randomisation sequence to standard of care (control group) or intra-arterial injection of autologous BMMNCs at one of two different doses (2 × 106 BMMNCs/kg or 5 × 106 BMMNCs/kg). The primary efficacy outcome was the proportion of patients with modified Rankin Scale scores of 0-2 at 180 days in the intention-to-treat population, comparing each BMMNC dose group and the pooled BMMNC group versus the control group. The primary safety endpoint was the proportion of serious adverse events. This trial was registered at ClinicalTrials.gov, NCT02178657 and is completed. FINDINGS: Between April 1, 2015, and May 20, 2021, we assessed 114 patients for eligibility. We randomly assigned 77 (68%) patients: 38 (49%) to the control group, 20 (26%) to the low-dose BMMNC group, and 19 (25%) the high-dose BMMNC group. The mean age of participants was 62·4 years (SD 12·7), 46 (60%) were men, 31 (40%) were women, all were White, and 63 (82%) received thrombectomy. The median NIHSS score before randomisation was 12 (IQR 9-15), with intra-arterial BMMNC injection done a median of 6 days (4-7) after stroke onset. The primary efficacy outcome occurred in 14 (39%) patients in the control group versus ten (50%) in the low-dose group (adjusted odds ratio 2·08 [95% CI 0·55-7·85]; p=0·28), eight (44%) in the high-dose group (1·89 [0·52-6·96]; p=0·33), and 18 (47%) in the pooled BMMNC group (2·22 [0·72-6·85]; p=0·16). We found no differences in the proportion of patients who had adverse events or dose-related events, but two patients had a groin haematoma after cell injection in the low-dose BMMNC group. INTERPRETATION: Intra-arterial BMMNCs were safe in patients with acute ischaemic stroke, but we found no significant improvement at 180 days on the mRS. Further clinical trials are warranted to investigate whether improvements might be possible at different timepoints. FUNDING: Instituto de Salud Carlos III co-funded by the European Regional Development Fund/European Social Fund, Mutua Madrileña, and the Regional Ministry of Health of Andalusia.

Endothelial NO synthase 786T/T polymorphism increases hemorrhagic transformation after endovascular thrombectomy.

BACKGROUND AND PURPOSE: This study examined whether the 786 NOS3 polymorphism is associated with the risk of hemorrhagic transformation (HT) in stroke patients with anterior large vessel occlusion (ALVO) treated using endovascular thrombectomy (EVT). METHODS: We performed an observational cohort study that included 118 patients with ALVO who underwent EVT. HT was assessed in follow-up CT and MRI. HT and non-HT patients were compared in terms of the 786 NOS3 polymorphism, flow mediated dilation (FMD) values within 3 days after the stroke, and collateral status based on three grading scales. Demographics, vascular risk factors, additional radiological data including ASPECT score, thrombus length and infarct size, and EVT procedure and outcome variables were also included. RESULTS: Radiological HT occurred in 55 (46.6%) patients and the 786T/T NOS3 polymorphism was associated with HT (unadjusted OR of 2.33, 95%CI: 1.05-5.20, adjusted OR of 3.14, 95%CI: 1.16-8.54). Collateral status and systemic endothelial function assessed by FMD were not mediators of this relationship as no differences were seen in the median FMD percentage values or collateral status between NOS3 genotypes. CONCLUSIONS: Our results suggest that genetic variations affecting the NO pathway, such as the 786 NOS3 polymorphism, may contribute to individual variability in the occurrence of HT and these results support involvement of this pathway in the pathogenesis of ischemia-reperfusion injury after EVT.

Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review.

Seventy percent of women with pelvic floor dysfunctions (PFDs) are estimated to present deficient consciousness of their pelvic floor muscles (PFMs) and poor ability to contract them. Improving the proprioception of PFMs, defined as the capacity to know the status and position of each body part, and adequately contracting them could be a protective factor to prevent the appearance of PFDs in the general female population. This study aimed to identify the effectiveness of educational interventions and verbal instructions on how to contract and exercise the PFMs to improve the proprioception of the PFMs in women. A systematic search of studies published in the last 20 years until March 2022 was conducted in the PubMed, Cochrane Library, Web of Science, Scopus, PEDro, Lilacs, and Dialnet databases. A meta-analysis could not be performed due to the heterogeneity in the types of studies and included populations. This review followed the PRISMA guidelines for the design, search, and reporting of studies. The methodological quality was analysed via the PEDro and the Newcastle-Ottawa scales in the case of randomised clinical trials and non-randomised studies, respectively, while the quality of evidence was determined using the SIGN grading system for evidence-based guidelines. Descriptive and experimental studies published in English, Spanish, or Portuguese that evaluated the contractile capability of the PFMs in healthy women or women without a previous diagnosis of PFD were included. Seven articles that included a total of 2507 women were found, three of which were clinical trials with PEDro scores between 5 and 9 points out of 10 and four of which were non-randomised studies with NOS scores between 6 and 8 points out of 10. The outcomes were measured through vaginal palpation, visual observation, questionnaires for PFD symptoms, and self-perception reports. This review discriminated between two types of intervention, educational programmes and verbal instructions, and evaluated the changes observed in PFM strength and knowledgeability and the symptoms of PFDs. The findings showed that educational interventions and verbal instructions improve the proprioception of PFMs in women of all ages that are healthy or without a previous diagnosis of PFDs as well as their knowledge about the pelvic floor, healthy lifestyle habits, and symptoms that are potentially indicative of PFDs. Further high-quality randomised clinical trials are warranted to draw definitive conclusions about the effectiveness of educational interventions to improve the proprioception of the PFMs in women considered healthy or with mild symptoms that may be indicative of PFDs.

Características demográficas y laborales del personal de enfermería con lumbalgia en hospital público de Corrientes, 2021 / Demographic and occupational characteristics of the nursing staff with low back pain in the public hospital of Corrientes, 2021

El dolor lumbar es una enfermedad laboral frecuente en enfermería, asociado a exigencias del cargo y múltiples causas. La intensidad varía según postura y actividad física, acompañándose de limitación dolorosa del movimiento, ser localizado, referido o irradiado. Objetivo: Determinar las características demográficas y laborales del personal de enfermería que presenta dolor lumbar de un hospital público de Corrientes, capital en el año 2021. Metodología: Diseño cuantitativo, transversal, observacional. Población 170 trabajadores de enfermería del hospital. Se incluyeron aquellos con dolor lumbar y que no cursaban enfermedades crónicas o invalidantes. Los datos se recogieron mediante cuestionario de elaboración propia, validado mediante prueba piloto. Variables: edad, género, formación en enfermería, frecuencia, intensidad y duración del dolor, principal tipo de dolor, tratamiento farmacológico y no farmacológico, principal situación generadora, tipo de trabajo realizado, turno y antigüedad laboral. Resultados: Se analizaron las respuestas de 115 trabajadores con dolor lumbar; amplitud etaria 22 a 62 años, promedio 36 años; 67% mujeres. El dolor lumbar fue diario en 22%, frecuente en 35%, ocasional en 43%. Según intensidad, 13% manifestó dolor leve, 47% moderado y 40% severo. El dolor era diario en 10% de jóvenes, en 20% de adultos jóvenes, en 45% de adultos intermedios y en 59% de adultos tardíos. En duración, el 73% lo padecía en forma aguda y el 27% crónica. En localización del dolor, el 75% indicó padecer dolor localizado y 25% irradiado. Principales situaciones generadoras de lumbalgia, 51% al movilizar pacientes, 23% al permanecer de pie, 18% al trasladar objetos pesados. En la percepción del personal sobre tipo de trabajo habitual, el 41% indicó pesado y 12% muy pesado. El 86%de los encuestados utilizó AINES. Conclusión: La intensidad del dolor lumbar es menor en el personal más joven respecto a los mayores. Los más jóvenes refieren dolor localizado, los de mayor edad dolor irradiado. El principal desencadenante del dolor lumbar es la movilización de pacientes[AU]

Low back pain is a common occupational disease in nursing, associated with the demands of the position and multiple causes. Te intensity varies according to posture and physical activity, accompanied by painful limitation of movement, being localized, referred or irradiated. Objective: To determine the demographic and labor characteristics of the nursing staff that presents low back pain in a public hospital in Corrientes, capital in the year 2021. Methodology: Quantitative, cross-sectional, observational design. Population 170 hospital nursing workers. Tose with low back pain and who did not have chronic or disabling diseases were included. Te data was collected through a self-prepared questionnaire, validated through a pilot test. Variables: age, gender, nursing training, frequency, intensity and duration of pain, main type of pain, pharmacological and nonpharmacological treatment, main generating situation, type of work performed, shif and work seniority. Results: Te responses of 115 workers with low back pain were analyzed; age range 22 to 62 years, average 36 years; 67% women. Low back pain was daily in 22%, frequent in 35%, occasional in 43%. According to intensity, 13% reported mild pain, 47% moderate and 40% severe. Pain was daily in 10% of youth, 20% of young adults, 45% of middle adults, and 59% of late adults. In duration, 73% suffered from it acutely and 27% chronically. In pain location, 75% indicated localized pain and 25% irradiated. Main situations that generate low back pain, 51% when moving patients, 23% when standing, 18% when moving heavy objects. In the perception of the personnel on the type of habitual work, 41% indicated heavy and 12% very heavy. 86% of those surveyed used NSAIDs. Conclusion: Te intensity of low back pain is lower in the younger staff compared to the older ones. Te youngest refer localized pain, the oldest radiated pain. Te main trigger of low back pain is the mobilization of patients[AU]

A lombalgia é uma doença ocupacional comum na enfermagem, associada às demandas do cargo e a múltiplas causas. A intensidade varia de acordo com a postura e atividade física, acompanhada de limitação dolorosa do movimento, sendo localizada, referida ou irradiada. Objetivo: Determinar as características demográfcas e laborais da equipe de enfermagem que apresenta lombalgia em um hospital público de Corrientes, capital no ano de 2021. Metodologia: Desenho quantitativo, transversal, observacional. População 170 trabalhadores de enfermagem hospitalar. Foram incluídos aqueles com lombalgia e que não possuíam doenças crônicas ou incapacitantes. Os dados foram coletados por meio de um questionário autoelaborado, validado por meio de um teste piloto. Variáveis: idade, sexo, formação do enfermeiro, frequência, intensidade e duração da dor, principal tipo de dor, tratamento farmacológico e não farmacológico, principal situação geradora, tipo de trabalho realizado, turno e antiguidade no trabalho. Resultados: Foram analisadas as respostas de 115 trabalhadores com lombalgia; faixa etária de 22 a 62 anos, média de 36 anos; 67% mulheres. A dor lombar foi diária em 22%, frequente em 35%, ocasional em 43%. De acordo com a intensidade, 13% relataram dor leve, 47% moderada e 40% intensa. A dor foi diária em 10% dos jovens, 20% dos adultos jovens, 45% dos adultos intermediários e 59% dos adultos tardios. Em duração, 73% sofriam agudamente e 27% cronicamente. Na localização da dor, 75% indicaram dor localizada e 25% irradiada. Principais situações que geram lombalgia, 51% ao movimentar pacientes, 23% ao fcar em pé, 18% ao movimentar objetos pesados. Na percepção do pessoal sobre o tipo de trabalho habitual, 41% indicaram pesado e 12% muito pesado. 86% dos entrevistados usaram AINEs. Conclusão: A intensidade da dor lombar é menor na equipe mais jovem em comparação com a mais velha. Os mais jovens referem dor localizada, os mais velhos referem dor irradiada. O principal desencadeador da lombalgia é a mobilização dos pacientes[AU]

Combined treatment of graft versus host disease using donor regulatory T cells and ruxolitinib.

Donor derived regulatory T lymphocytes and the JAK1/2 kinase inhibitor ruxolitinib are currently being evaluated as therapeutic options in the treatment of chronic graft versus host disease (cGvHD). In this work, we aimed to determine if the combined use of both agents can exert a synergistic effect in the treatment of GvHD. For this purpose, we studied the effect of this combination both in vitro and in a GvHD mouse model. Our results show that ruxolitinib favors the ratio of thymic regulatory T cells to conventional T cells in culture, without affecting the suppressive capacity of these Treg. The combination of ruxolitinib with Treg showed a higher efficacy as compared to each single treatment alone in our GvHD mouse model in terms of GvHD incidence, severity and survival without hampering graft versus leukemia effect. This beneficial effect correlated with the detection in the bone marrow of recipient mice of the infused donor allogeneic Treg after the adoptive transfer.

Individualized Analysis of Lateral Asymmetry Using Hip-Knee Angular Measures in Soccer Players: A New Methodological Perspective of Assessment for Lower Limb Asymmetry.

This study aimed to: (1) determine the magnitude and direction of lateral asymmetry in well-trained soccer players using hip and knee ROM tests; (2) inquire if asymmetry relies on the ROM test performed and/or gender; and (3) establish asymmetry thresholds for each ROM test to individualize lower-limbs asymmetry. One hundred amateur soccer players were assessed using hip-knee ROM tests: Straight Leg Raise, modified Thomas Test, hip internal rotation and external rotation, hip abduction (ABD) and adduction (ADD), Nachlas Test and Rigde Test. There are significant differences between tests when determining the magnitude of lateral asymmetry (F = 3.451; p = 0.001; ηp2 = 0.031) without significant differences between gender (F = 0.204; p = 0.651; ηp2 = 0.001). Asymmetry threshold results differ significantly between using a fixed or a specific threshold (F = 65.966; p = 0.001; ηp2 = 0.985). All tests indicate that the direction of asymmetry is towards the dominant limb. In conclusion, the ROM test used determines the magnitude and direction of the lateral asymmetry of the amateur soccer players. The ABD and ADD are the ROM tests that showed higher percentages of asymmetry, without differences between female and male soccer players. Using a specific asymmetry threshold formula can classify more players as asymmetrical than with a fixed threshold.

Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series.

This study aimed to investigate changes in the pain sensory profile of women with breast cancer. Five women with unilateral breast cancer were enrolled. Participants were assessed with direct (quantitative sensory testing, QST) and indirect measures of pain sensitization (self-reported central sensitization inventory, CSI) at baseline (before surgery), 1 week after surgery, and at 1, 6, 9, and 12 months post-surgery. In the event of pain occurrence, the Leeds Assessment of Neuropathic Symptoms and Signs was also used. Nociceptive pain was the predominant pain mechanism in the postoperative period, while an increase in sensitization predominated one year after breast cancer surgery, especially in those participants who had received more treatment procedures. The participants who received more therapies for breast cancer experienced persistent pain and a higher level of sensitization. An assessment protocol including direct measurements (QST) and indirect measurement (self-reported CSI) allows for detecting changes in pain sensitivity, which can be useful for characterizing and/or predicting pain before, during, and up to one year following surgical interventions for breast cancer.

Women's Experiences with Compliance with Pelvic Floor Home Exercise Therapy and Lifestyle Changes for Pelvic Organ Prolapse Symptoms: A Qualitative Study.

In this study, we aimed to investigate women's experiences with compliance with prescribed pelvic floor muscle exercises (PFMEs) and lifestyle changes 6-12 months after completing an individual pelvic floor physiotherapy program. This study was targeted to understanding factors affecting adherence to PFMEs and lifestyle changes to deal with pelvic organ prolapse (POP) symptoms. We designed this research as a descriptive qualitative study. We conducted this study from December 2016 to September 2017 in Madrid, Spain. Twenty-six women with symptomatic POP selected using a purposive sampling method participated in six focus groups and three one-to-one semi-structured interviews. Three authors coded and inductively analyzed transcript contents with iterative theme development. A thematic analysis revealed three main themes: (1) symptoms change; (2) PFMEs and lifestyle changes performance; and (3) a health practitioner-patient relationship. Women identified as adherent reported improvement in physical symptoms and emotional and general state as a result of the new knowledge achieved. Fear also promoted compliance with performing PFMEs and adopting lifestyle changes. Likewise, PFMEs preference and routine, integration of PFMEs and lifestyle changes into activities of daily living, support guides, therapeutic alliance, individual supervision, follow-up, and feedback were also identified as adherence facilitators. One of the biggest barriers that we identified was responsibility. Compliance with prescribed PFMEs and lifestyle changes can be improved with effective individual, women-centered, and supervised physiotherapy programs reducing symptoms, including exercises aligned with women's preferences that are easy to integrate in daily living, promoting knowledge and awareness of their condition, providing written or electronic guidelines, with routine follow-up visits offering both positive feedback and clear and consistent messages, and enhancing therapeutic alliance.

Online Information on Painful Sexual Dysfunction in Women: Quality Analysis of Websites in SPANISH about Dyspareunia, Vaginismus and Vulvodynia.

The objective of this study was to evaluate the content, quality, and readability of websites containing information on dyspareunia, vaginismus, and vulvodynia in Spanish. Web pages were retrieved entering the terms "dyspareunia", "vaginismus", and "vulvodynia" in Google, Yahoo!, and Bing search engines. Two researchers employed the DISCERN and Bermúdez-Tamayo questionnaires to analyze the content and quality of the websites, and the INFLESZ scale to evaluate their readability. IBM SPSS® version 25 statistical software was employed for data analysis. The internet search yielded 262 websites, 91 of which were included after applying the selection criteria. Websites with information on dyspareunia obtained median scores of 24 (30-21) in the DISCERN, 38 (41.0-35.5) in the Bermúdez-Tamayo, and 55.3 (57.2-50.9) in the INFLESZ tools. The results for websites on vaginismus revealed median scores of 23.5 (30-20) in the DISCERN, 37 (42-35) in the Bermúdez-Tamayo, and 52.9 (55.6-46.4) in the INFLESZ. Finally, the median scores for vulvodynia sites was 25.5 (30-20) in the DISCERN, 38 (43-33.7) in the Bermúdez-Tamayo, and 54.2 (57.3-47.2) in the INFLESZ. These outcomes indicate that the quality of information in these websites is very low, while the overall quality of the web pages is moderate. Sites on vaginismus and vulvodynia were "somewhat difficult" to read, while readability was "normal" for websites on dyspareunia. Healthcare professionals should be aware of the shortcomings of these websites and address them through therapeutic education with resources containing updated, quality information. This raises the need for health professionals to generate these resources themselves or for experts and/or scientific societies in the field to check the quality and timeliness of the contents, regardless of whether or not the websites are endorsed with quality seals.

Manual Lymph Drainage With Progressive Arm Exercises for Axillary Web Syndrome After Breast Cancer Surgery: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to determine the effectiveness of a physical therapist-designed program tailored to axillary web syndrome (AWS) in women after breast cancer surgery. METHODS: A prospective, single-center, assessor-blinded, randomized controlled trial was conducted at the Physiotherapy in Women's Health Research Unit of the Alcalá University (Madrid, Spain). Ninety-six women with AWS were assigned to the physical therapy group (manual lymph drainage [MLD] using resorption strokes and arm exercises as if performing median nerve neurodynamic glide exercises with no neural loading; n = 48) or the control group (standard arm exercises; n = 48), with both groups receiving treatment 3 times a week for 3 weeks. Both interventions included an educational component. RESULTS: Compared with the control group, the physical therapy group showed significant and clinically relevant improvements in the primary outcome (self-reported pain intensity) at the primary and 3-month follow-ups. Significant and clinically relevant differences between groups were also found in the secondary outcomes (shoulder active range of motion, shoulder disability, and physical and functional aspects of health-related quality of life) at the primary follow-up and in the secondary outcomes as well as the trial outcome index at the 3-month follow-up. No significant differences were found at the 6-month follow-up in either primary or secondary outcomes. CONCLUSION: The physical therapy program tailored to AWS was found to be effective for AWS symptoms in women after breast cancer surgery, both immediately after the program and after 3 months. IMPACT: To our knowledge, this is the first appropriately designed study to demonstrate the effectiveness of MLD with progressive arm exercises for AWS. Clinicians and health service providers should consider how to provide survivors of breast cancer with AWS the opportunity to participate in physical therapy programs, including MLD with progressive arm exercises. LAY SUMMARY: For axillary web syndrome following breast cancer surgery, a physical therapist can design a treatment program including manual lymph drainage and progressive arm exercises, which has been shown to result in reduced pain and improved motion compared with standard arm exercises.

Effectiveness of Therapeutic Exercise and Patient Education on Cancer-Related Fatigue in Breast Cancer Survivors: A Randomised, Single-Blind, Controlled Trial with a 6-Month Follow-Up.

This study aimed to determine the effectiveness of therapeutic exercise plus patient therapeutic education on perceived fatigue, functional capacity and pain in breast cancer survivors with cancer-related fatigue. A randomised, single-blind, clinical trial was conducted with a total of 80 breast cancer survivors who presented cancer-related fatigue. Women were randomised into a supervised therapeutic exercise group (STE-G) (n = 40) or an unsupervised exercise group (UE-G) (n = 40). Both interventions included patient therapeutic education and were delivered in three sessions per week over eight weeks. The main outcome was perceived fatigue as assessed by the Spanish version of the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-F). Other evaluated outcomes were pain measured on a visual analogue scale, and distance measured using the 6-Minute Walk Test. Data were collected at baseline, immediately post-intervention, and at three and six months after baseline. Significantly greater improvements across all variables were observed in the STE-G throughout the entire follow-up period with the exception of pain. Conclusions: A supervised therapeutic exercise program plus patient therapeutic education significantly reduce perceived fatigue and increase functional capacity in breast cancer survivors suffering from cancer-related fatigue compared to an unsupervised physical exercise program based on individual preferences with patient therapeutic education.

What Influences Women to Adhere to Pelvic Floor Exercises after Physiotherapy Treatment? A Qualitative Study for Individualized Pelvic Health Care.

Conservative treatment of pelvic floor dysfunction (PFD) includes therapeutic exercise for pelvic floor muscle (PFM) training or other complementary exercise modalities, such as hypopressive exercises. However, the long-term effectiveness of the conservative treatment depends on a patient's adherence to the exercises and the integration of professional health advice into their daily life. The objective of this study was to establish the adherence experience of women with diagnosed PFD in home-based exercises after an intensive face-to-face physiotherapy treatment. A qualitative study from an interpretive paradigm was developed. Semi-structured individual and group interviews were performed 6 months after finishing individual physiotherapy treatment. The interviews were recorded, fully transcribed and analyzed thematically by creating categories. Thirty-one women were interviewed. The women reported that their adherence to home PFM exercises depended on the exercise program itself, its efficacy, their personal experiences with the exercises, intrinsic factors such as self-awareness or beliefs, and extrinsic factors, such as professional or instrumental feedback. Thus, therapeutic adherence could be more likely with effective physiotherapy programs that include mutually agreed home exercises and simple movements women can build into their daily lives. Improving awareness and knowledge of the pelvic region and the importance of PFM treatment as well as consideration for potential worsening of PFD will also encourage women to adhere to the exercises.

Changes in shoulder outcomes using ultrasonographic assessment of breast cancer survivors: a prospective longitudinal study with 6-month follow-up.

This study aimed to describe changes in supraspinatus tendon thickness, acromiohumeral distance, and the presence of fluid in the subacromial bursa as measured by ultrasound, as well as shoulder range of motion and strength, perceived shoulder disability, and health-related quality of life in women before and after breast cancer treatment. Women who underwent surgery for unilateral breast cancer who did not suffer from shoulder pain or difficulty performing activities of daily living in the 6 months prior to surgery were included. One pre-surgical (A0) and three post-surgical assessments at 7-10 days (A1), 3 months (A2), and 6 months (A3) after surgery were carried out. The thickness of the supraspinatus tendon on the affected side decreased between post-surgical (A1) and 6-month (A3) follow-up assessments (p = 0.029), although the minimal detectable change was not reached. The active range of motion of the affected shoulder decreased after surgery. Strength changes were observed in both shoulders after surgery. The intensity of shoulder pain increased between post-surgical and 6-month follow-up assessments. Shoulder function was decreased at the post-surgical assessment and increased throughout the follow-ups. Health-related quality of life declined after surgery. A trend of decreasing thickness of the supraspinatus tendon of the affected shoulder was observed. Detecting these possible structural changes early would allow for early or preventive treatment.

Improving river hydromorphological assessment through better integration of riparian vegetation: Scientific evidence and guidelines.

River hydromorphology has long been subjected to huge anthropogenic pressures with severe negative impacts on related ecosystems' functioning and water quality. Therefore, improving river hydromorphological conditions represents a priority task in sustainable river management and requires proper assessment tools. It is well known that riparian vegetation plays a crucial role in sustaining river hydromorphological conditions. However, it has been nearly neglected in most hydromorphological assessment protocols, including the European Water Framework Directive (WFD). This paper reviews and synthesizes the relevance of riparian vegetation for river hydromorphology, focusing on its contribution to streamflow and sediment regime conditions. We also examine how riparian vegetation is considered in the WFD and how it is included in national hydromorphological protocols currently in use. Our findings point to a temporal mismatch between the date when the WFD came into force and the emergence of scientific and technologic advances in riparian vegetation dynamism and bio-geomorphic modeling. To overcome this misalignment, we present promising approaches for the characterization and assessment of riparian vegetation, which include the identification of vegetation units and indicators at multiple scales to support management and restoration measures. We discuss the complexity of riparian vegetation assessment, particularly with respect to the establishment of river-type-based reference conditions and the monitoring and management targets, and propose some attributes that can serve as novel indicators of the naturalness vs. artificiality of riparian vegetation. We argue that the hydromorphological context of the WFD should be revisited and offer guidance to integrate riparian vegetation in river hydromorphological monitoring and assessment.

Assessment Tools of Patient Competences: The Spanish Version of the R-NPQ and Three Practical Cases in Women with Breast Cancer and Persistent Pain.

Persistent pain following treatment for breast cancer (PPBCT) is a prevalent and complex clinical issue. Education together with physiotherapy have been shown to lessen pain and disability in chronic pain. Although the evaluation of the patient's competences is a major part of the educational program, the published educational programs rarely describe the tools used to assess competences, especially regarding those related to decision-making and problem-solving. The aim of this study was to provide two competences assessment tools: the cross-cultural adaptation and validation of the Spanish version of the Revised Neurophysiology of Pain Questionnaire (R-NPQ) and practical cases of women with PPBCT. The Spanish cross-cultural adaptation was conducted following recognized criteria. Measurement properties testing included an analysis of construct validity (known-groups approach), reliability (internal consistency and test-retest reliability), responsiveness, interpretability, and feasibility. To promote a tool that would allow evaluation of the educational program competences, a group of experts developed three cases extracted from real contexts by means of an iterative process. A total of 80 women with PPBCT (mean age 56 years) and 81 physiotherapy students (mean age 20 years) participated in the measurement properties analysis. The three developed cases were presented to the same 80 women with PPBCT before and after the educational program. As we expected, students showed a significantly higher score (p < 0.001) than did women with PPBCT in the R-NPQ questionnaire, with a large effect size (d = 2.49), demonstrating good construct validity. The Cronbach alpha was 0.90 (95% CI, 0.87-0.92) and the intraclass correlation coefficient was 0.82 (95% CI, 0.73-0.88). A large effect size (5.2) was found, as we expected, between baseline and post-treatment scores, suggesting adequate responsiveness. In addition, identifying and analyzing, decision making, communicating needs, knowing how to manage, and problem-solving skills were evaluated through the three practical cases. Most women (88.75%) reached the highest level in the assessment rubric of the proposed practical cases. The Spanish R-NPQ is a comprehensible, valid, reliable, and responsive tool for Spanish women with PPBCT. The practical cases are a useful competence assessment tool and were well accepted by women with PPBCT. Further studies are needed to investigate more competence assessment tools and to investigate whether the achievement of different levels of competences has an effect on health behaviors.

Age Differences in Motor Recruitment Patterns of the Shoulder in Dynamic and Isometric Contractions. A Cross-Sectional Study.

Aging processes in the musculoskeletal system lead to functional impairments that restrict participation. Purpose: To assess differences in the force and motor recruitment patterns of shoulder muscles between age groups to understand functional disorders. A cross-sectional study comparing 30 adults (20-64) and 30 older adults (>65). Surface electromyography (sEMG) of the middle deltoid, upper and lower trapezius, infraspinatus, and serratus anterior muscles was recorded. Maximum isometric voluntary contraction (MIVC) was determined at 45° glenohumeral abduction. For the sEMG signal registration, concentric and eccentric contraction with and without 1 kg and isometric contraction were requested. Participants abducted the arm from 0° up to an abduction angle of 135° for concentric and eccentric contraction, and from 0° to 45°, and remained there at 80% of the MIVC level while isometrically pushing against a handheld dynamometer. Differences in sEMG amplitudes (root mean square, RMS) of all contractions, but also onset latencies during concentric contraction of each muscle between age groups, were analyzed. Statistical differences in strength (Adults > Older adults; 0.05) existed between groups. No significant differences in RMS values of dynamic contractions were detected, except for the serratus anterior, but there were for isometric contractions of all muscles analyzed (Adults > Older adults; 0.05). The recruitment order varied between age groups, showing a general tendency towards delayed onset times in older adults, except for the upper trapezius muscle. Age differences in muscle recruitment patterns were found, which underscores the importance of developing musculoskeletal data to prevent and guide geriatric shoulder pathologies.