Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study.

Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation.

Metronomic vinorelbine is an excellent and safe treatment for advanced breast cancer: a retrospective, observational study.

Advanced breast cancer (ABC) has become a chronic disease. In such a situation, an effective therapy with low toxicities and economically acceptable is needed. Metronomic vinorelbine (mVNR) has been proved to be effective on the control of MBC. The aim of this study is to evaluate the efficacy and safety of mVNR as the salvage therapy for patients with ABC. Oral vinorelbine (VNR) was administered at 70 mg/m2, fractionated on days 1, 3, and 5, for 3 weeks on and 1 week off. Once the mVNR was combined with trastuzumab, or was combined with bevacizumab, the schedule was changed to 2 weeks on and 1 week off. Clinical data of patients with ABC who had received treatment with mVNR and tumor characteristics were collected and analyzed. From Mar. 2013 to Dec, 2020, there were 90 patients with ABC received mVNR. The overall response rate was 53.3% and overall disease control rate (DCR) was 78.9% in this study, including 4 (4.4%) cases reached complete response, 44 (48.9%) cases reached partial response and 23 (25.6%) cases were table disease. The median time to treatment failure (TTF) of the Lumina A patients was 13.3 months, Lumina B patients was 9.1 months, Her-2 enrich patients was 8.9 months, and triple negative breast cancer (TNBC) patients was 5.6 months. Median overall survival time for Lumina A, Lumina B, Her-2 enrich and TNBC were 54.6 months, 53.3 months, 59.5 months and 24.5 months separately. Side effects were minimal and manageable. Metronomic VNR can be an effective treatment for ABC either works as a switch maintenance or salvage therapy. In combination with target therapy or hormonal therapy, mVNR can further improve TTF and DCR with minimal toxicities. Further study should focus on the optimal dosage, schedule and combination regimen.

Long-term survival and prognostic implications of patients with invasive breast cancer in southern Taiwan.

Our objective in this study was to determine the survival rate of patients with invasive breast cancer and identify the prognostic factors related to all-cause mortality during a 10-year follow-up.Analysis was performed on the medical records of 2002 patients newly diagnosed with breast cancer at a medical center in southern Taiwan between 2006 and 2017. The Kaplan-Meier method and Cox regression analysis were used to estimate survival and the independence of prognostic factors associated with all-cause mortality.Among the 2002 patients, 257 expired during the 10-year follow-up period. The overall survival rates were as follows: 3 years (91.1%), 5 years (85.6%), and 10 years (77.9%). The median survival time was 120.41 months (95% confidence interval: 118.48-122.33 months). Older age, pathologic tumor status, regional lymph node metastasis, distant metastasis, grade/differentiation, treatment modalities, and hormone therapy were significantly related to all-cause mortality.This study identified several clinical factors related to all-cause mortality as well as its relationship to distant metastasis and poor differentiation. Early diagnosis and treatment aimed at preventing recurrence are the keys to survival.

The effects of aromatherapy massage on improvement of anxiety among patients receiving palliative care: A systematic review of randomized controlled trials.

BACKGROUND: Anxiety in patients receiving palliative care is a noteworthy concern because it may affect their quality of life. Aromatherapy has been widely utilized to improve anxiety among patients receiving palliative care. OBJECTIVE: To investigate the effectiveness of anxiety improvement in patients receiving palliative care by comparing the intervention group (aromatherapy massage) with the control group (common massage alone). METHODS: A literature search was performed using PubMed, Cochrane Library, Embase, MEDLINE, and CINAHL for all related studies from inception through November 30, 2018 without restriction on language. A quantitative synthesis of randomized controlled trials (RCTs) was conducted to compare the difference in effectiveness scores between the aromatherapy massage and only common massage groups by employing a random-effect model. RESULTS: We included three RCTs with a total of 160 participants (81 in the intervention group and 79 in the control group) in our systematic review and conducted a quantitative synthesis. The secondary data from the reviewed trials were then pooled using a random-effect model. Anxiety (mean difference = -2.60 [95% confidence interval: -7.82, 2.63], P = .33) was assessed using anxiety scores from the State-Trait Anxiety Inventory. CONCLUSION: Compared with common massage alone, aromatherapy massage does not provide significant effectiveness of anxiety improvement among patients receiving palliative care.

Music intervention for pain and anxiety management of the primiparous women during labour: A systematic review and meta-analysis.

AIMS: To determine the effect of music on the management of pain and anxiety in primiparous women during labour. BACKGROUND: Music is cost-effective intervention in clinical practice to reduce pain, stress, and anxiety. However, a systematic review with meta-analysis for investigating its effects during labour is still lacking. DESIGN: A systematic review with meta-analysis. DATA SOURCES: MEDLINE, EMBASE, and CINAHL databases. REVIEW METHODS: Randomized controlled trials or quasi-experimental trials concerning the effects of music among primiparous women who were expected to give normal spontaneous delivery were searched and screened up to 31 July 2017. The recruited trials for this review were compliant with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: A total of 392 primiparous pregnant women (197 in the music intervention group and 195 in the routine care group) from five studies were included in this review. Music as an intervention seemed to lower the pain scores for primiparous women during labour, but the effect was not statistically significant. However, there was a significant benefit of music intervention compared with routine care for primiparous women during labour. In the sensitivity analysis, music intervention showed significant effect on the improvement of pain and anxiety for primiparous women during labour. CONCLUSION: Music intervention may be an effective intervention for the management of pain and anxiety for primiparous women during labour.

Risk factors associated with newly psychiatric disorder in spinal cord injury: A retrospective cohort study.

AIM AND OBJECTIVES: To predict the risk factors related to newly diagnosed psychiatric disorders resulting from spinal cord injuries (SCIs). BACKGROUND: SCIs are a common result of devastating accidents; they can have an essential negative impact on the psychological health of those so afflicted. Psychiatric disorders commonly occur worldwide and are often associated with pain and disability; however, few studies have investigated the risk factors of psychiatric disorders among persons with SCIs. DESIGN: A retrospective cohort study design with data obtained from the Taiwan Health Insurance Research Database (THIRD). THIRD involves the claims data on recipients recorded in the Taiwan National Health Insurance (TNHI), which was set up in 1995 and covers about 99% of the 23 million persons in Taiwan. METHODS: We used THIRD to predict the risk factors related to newly diagnosed psychiatric disorders among victims of spinal cord injury. RESULTS: The majority of persons with SCI were men (51.2%), and their average age was 52.8 years. All 5,828 newly diagnosed psychiatric disorders were included from 1997-2009 in 64,907 SCI in the THIRD data set. These results demonstrated notable differences in hazard risk (HR); the injured persons were inspected for the level of SCI, age, hypertension and chronic obstructive pulmonary disease (HR: 1.637, 95% CI: 1.452-1.844, p < .0001; HR: 1.005, 95% CI: 1.002-1.009, p = .0019; HR: 0.724, 95% CI: 0.642-0.816; HR: 1.267, 95% CI: 1.105-1.454, p = .0007; HR: 1.368, 95% CI: 1.183-1.582, p < .0001, respectively); the persons with SCI exhibited significant independent associations with psychiatric disorders. CONCLUSIONS: The results revealed that the level of SCI, female gender and age, respectively, affects the incidence of newly diagnosed psychiatric disorder related to SCI. RELEVANCE TO CLINICAL PRACTICE: This study showed that psychiatric disorders may be associated with the development of SCI, and that this risk was more predominant in females with SCI. Our results are of direct clinical relevance as they are meant to assist clinical assessment, counselling, guidance of symptomatic monitoring and early clinical intervention.

Post-mastectomy radiotherapy benefits subgroups of breast cancer patients with T1-2 tumor and 1-3 axillary lymph node(s) metastasis.

BACKGROUND: To determine the role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-2 and N1 disease. PATIENTS AND METHODS: A total of 207 postmastectomy women were enrolled. The 5-year Kaplan-Meier estimates of locoregional recurrence rate (LRR), distant recurrence rate (DRR) and overall survival (OS) were analyzed by different tumor characteristics. Multivariate analyses were performed using Cox proportional hazards modeling. RESULTS: With median follow-up 59.5 months, the 5-year LRR, DRR and OS were 9.1%, 20.3% and 84.4%, respectively. On univariate analysis, age < 40 years old (p = 0.003) and Her-2/neu over-expression (p = 0.016) were associated with higher LRR, whereas presence of LVI significantly predicted higher DRR (p = 0.026). Negative estrogen status (p = 0.033), Her-2/neu overexpression (p = 0.001) and LVI (p = 0.01) were significantly correlated with worse OS. PMRT didn't prove to reduce 5-year LRR (p = 0.107), as well as 5-year OS (p = 0.918). In subgroup analysis, PMRT showed significant benefits of improvement LRR and OS in patients with positive LVI. CONCLUSIONS: For patients with T1-2 and N1 stage breast cancer, PMRT can decrease locoregional recurrence and increase overall survival only in patients with lymphovascular invasion.

An evaluation of focal adhesion kinase in breast cancer by tissue microarrays.

BACKGROUND: Many studies have shown that focal adhesion kinase (FAK) is a positive regulator of tumor progression and invasion. However, there is still very limited information about the role of FAK in breast cancer. Tissue microarrays (TMA) can analyze thousands of tissue samples in a parallel fashion with minimal damage to the origin block. This study was designed with the application of TMA to analyze the FAK status in breast cancer. PATIENTS AND METHODS: Archival tissue specimens from 98 patients with primary invasive breast cancer were selected and FAK expression was analyzed by immunohistochemical staining with TMA. The data of primary tumor staging, age, estrogen receptor status, lymph node status, histological grading and TNM staging were also collected. RESULTS: There were four patients (4.0%) with grade 1 expression in FAK, 41 patients (41.8%) with grade 2 expression in FAK and 53 patients (54.2%) with grade 3 expression in FAK. There was no significant relationship between FAK expression and age, estrogen receptor status, histological grading, primary tumor staging, lymph node status and TNM stage. By multivariate analysis, the TNM stage was found to be significantly related to the overall five-year survival rate (p<0.00001). CONCLUSION: Immunohistochemical staining with TMA is a convenient and feasible method. Unfortunately, our preliminary results fail to show meaningful prognostic value of FAK in breast cancer. A larger prospective study is warranted for further evaluation.

Yes-associated protein is not an independent prognostic marker in breast cancer.

BACKGROUND: The development of tissue microarray (TMA) technology has provided the opportunity to perform analyses of tissue samples on a large scale in an uniform fashion. This study was designed with the use of TMA to explore the Yes-associated protein (YAP) status in breast cancer. PATIENTS AND METHODS: YAP expression in tumor and tumor-free samples from 94 patients with primary breast cancer was analyzed by TMA. The clinicopathological data for age, estrogen receptor status, histological grading and TNM staging were also collected. RESULTS: There were 29 patients (30.8%) with 1(+) expression, in YAP, 59 patients (62.8%) with 2(+) expression and 6 (6.4%) with 3(+) expression. There was no significant relationship between YAP expression and the other clinicopathological variables. By multivariate analysis, YAP expression failed to produce any significant relationship with the overall survival rate. CONCLUSION: YAP expression is not an independent prognostic factor in patients with breast cancer.

Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia.

BACKGROUND: Post-thyroidectomy tracheomalacia is a rare but complicated problem. It has often been treated with tracheostomy or prolonged endotracheal intubation. However, noninvasive positive pressure ventilation (NPPV) has been successfully employed with increasing frequency in patients with respiratory failure from other causes. In the present study we describe the use of NPPV in the management of respiratory distress in patients with post-thyroidectomy tracheomalacia. METHODS: All 606 patients who underwent thyroidectomy in Chung Gung Memorial Hospital - Kaohsiung Medical Center, Taiwan, from January 2009 to August 2010 were reviewed. If tracheomalacia was diagnosed intraoperatively, the patients were left intubated and taken to the intensive care unit (ICU) (n = 5). If tracheomalacia was diagnosed in the recovery room (stridor and airway compromise not from other causes), the patient was reintubated promptly and taken to the ICU (n = 4). When subsequently re-extubated in the ICU (24-72 h later), NPPV was used to treat recurrent stridor and airway compromise. RESULTS: A total of nine patients (1.5 %) were diagnosed with post-thyroidectomy tracheomalacia, five intraoperatively and four postoperatively. The patients were intubated with an endotracheal tube and then taken to the ICU. After early re-extubation in the ICU, three of the patients with intraoperatively diagnosed tracheomalacia were found not to have respiratory problems, whereas the other six patients developed stridor and airway compromise, which resolved immediately with the initiation of NPPV. Hemoglobin oxygen saturation on pulse oximetry was also elevated. No further respiratory support was required and no complications occurred in these patients. CONCLUSIONS: Noninvasive positive pressure ventilation is effective and appears safe in the management of stridor and airway compromise following early extubation in patients with post-thyroidectomy tracheomalacia.

Clustered microcalcifications of intermediate concern detected on digital mammography: ultrasound assessment.

To report our experience with targeted-ultrasound in assessing 142 cases with clustered microcalcifications of intermediate concern detected on digital mammography. All cases had histopathologically-proven microcalcifications within the biopsied or surgical specimens. There were 30%[43/142] breast cancers and 70%[99/142] benign lesions. Only 26%[37/142] of clustered microcalcifications were identified on targeted-ultrasound and other findings including negative study (n = 33), anechoic ducts or cysts (n = 70), dilated ducts with echogenic content (n = 13) and hypoechoic nodules (n = 26). There was no statistical difference of the frequency of negative ultrasound between benign and malignant microcalcifications (P = 0.071). However, only 7.1%[5/70] cases with anechoic ducts or cysts were proven to be breast cancer. The frequencies of depiction of dilated ducts with echogenic foci or hypoechoic nodules were significantly higher for malignant microcalcifications (P < 0.001). Ultrasound was significantly more sensitive for the identification of malignant cases but biopsy of clustered microcalcifications is still warranted when targeted-ultrasound revealed negative findings.

Weekly paclitaxel combining with gemcitabine is an effective and safe treatment for advanced breast cancer patients.

OBJECTIVE: Patients with metastatic breast cancer usually accept several lines of chemotherapy. This retrospective study is to analyze the therapeutic effect and tolerance of weekly paclitaxel/gemcitabine combination on patients with metastatic breast cancer. METHODS: Paclitaxel 80 mg/m(2) and gemcitabine 800 mg/m(2) were administered sequentially on days 1, 8 and 15 every 28 days. Patients with measurable metastatic breast cancer or locally advanced breast cancer were included. RESULTS: From March 2005 to December 2006, 50 patients received this treatment at Chang Gung Memorial Hospital, Kaohsiung Medical Center. Thirteen (26%) patients accepted this regimen as their first-line treatment for metastatic breast cancer and 25 (50%) patients accepted this regimen after at least three lines of therapies for metastatic breast cancer. The overall response rate was 56% (95% confidence interval: 42.2-69.8%), 2 patients achieved complete response and 26 patients (52, 95% confidence interval: 38.2-65.9%) achieved partial response. The median progression free survival was 7.4 months (95% confidence interval: 5.5-9.3 months), and the median overall survival was 19.0 months (95% confidence interval: 9.7-28.3 months). Except alopecia, the most common Grade 3/4 toxicities were anemia and leucopenia; the incidences of both were fewer than 10%. CONCLUSIONS: The combination of weekly gemcitabine and paclitaxel in patients with advanced breast cancer showed acceptable outcome and excellent toxic profiles. This therapeutic benefit could be achieved in any linage of patients with good performance status; earlier usage of this regimen can provide better result.

Hand-assisted laparoscopic splenectomy--preliminary experience in southern Taiwan.

BACKGROUND: A hand-assisted laparoscopic procedure allows the surgeon to insert the nondominant hand into the abdomen, and helps to recover the tactile sensation. For a massively enlarged spleen, this technique overcomes difficulty in conventional laparoscopic splenectomy. The advantages of minimally-invasive surgery can still be preserved. We describe our preliminary experience in hand-assisted laparoscopic splenectomy. METHODS: The data of 5 patients who presented with splenomegaly and underwent hand-assisted laparoscopic splenectomy between April 2000 and January 2004 were reviewed retrospectively for analysis. RESULTS: The mean age was 45.4 +/- 6.6 years, and the hospital stay was 6.6 +/- 1.0 days. The splenic length and weight averaged 20.6 +/- 5.9 cm and 1084.2 +/- 647.8 g. The operative time and blood loss averaged 218.2 +/- 40.2 minutes and 220 +/- 166.1 ml. There was no conversion to open splenectomy. No mortality or morbidity was noted in our series. CONCLUSION: Hand-assisted laparoscopic splenectomy is a safe and feasible procedure, even in our initial experience. It helps in exploration of the surgical field and handling of a fragile spleen, especially in patients with massively enlarged spleens. Although another incision is necessary, the advantages of laparoscopic surgery are still retained.

Quadrapod mesh for posterior wall reconstruction in adult inguinal hernias.

Inguinal hernia repairs are the most frequently carried out operations worldwide, and open-mesh herniorrhaphies have gained wide acceptance for advantages of little tension, less pain and lower recurrence rates. Even so, potential drawbacks of original open-mesh repairs exist, and we accordingly make some modifications, suggesting a new 'quadrapod' marlex mesh as an alternative. From July 2002 to March 2004, we carried out 288 consecutive inguinal hernia repairs using quadrapod mesh in 273 patients, all of them were male and aged older than 35 years. Patient demographics, operative parameters, morbidity and outcomes were collected in detail. After surgery, patients were followed up every 6 months at one surgeon's clinic and any major abnormality was recorded. Mean age of the 273 patients was 58.7 years. Twenty-eight patients had recurrent hernias and 15 bilateral hernias. Mean surgical duration was 50.7 min. One patient suffered from major wound infection and needed prolonged hospitalization for parenteral antibiotics. Owing to old age and benign prostatic hyperplasia, 11 patients receiving spinal anaesthesia had temporary postoperative urine retention and needed short-term urinary catheter insertion. Most patients were discharged 1 day following surgery. Acute wound pain generally improved within days, and no patients complained of chronic pain or debility necessitating special interventions. With a mean follow up of 40.7 months, no case of recurrent herniation was detected to date. Open-mesh herniorrhaphy using quadrapod mesh provides a cheap, feasible and effective alternative choice in centres with limited resources. Preliminary results are encouraging, and a formal prospective study may be warranted.

Intestinal obstruction caused by intraoperative mass reduction of an incarcerated inguinal hernia--report of a case.

Now that inguinal hernia repair is a feasible and safe procedure, mass reduction of an incarcerated inguinal hernia, usually resulting from forceful taxis during non-operative manual reduction, has became a rare occurrence. We present an even rarer complication: intraoperative mass reduction of an incarcerated inguinal hernia. Following herniorrhaphy, the patient was initially well, but symptoms of intestinal obstruction appeared gradually, and he presented with intestinal obstruction 2 weeks after herniorrhaphy. Imaging studies aroused suspicion of mass reduction and surgery confirmed the diagnosis. We highlight some peculiar physical findings and remind readers of the existence of such a rare complication, which can occur following herniorrhaphy, and be masked by a short period of symptomatic relief.

Partial splenectomy for benign splenic cysts with the aid of a Lin clamp: technical note.

BACKGROUND: Spleen-preserving procedures deserve every effort by surgeons to reduce the risk of overwhelming postsplenectomy infection. Partial splenectomy at hospitals with restricted sources remains technically demanding. We describe our method of partial splenectomy for benign splenic cysts with the aid of a Lin clamp. PATIENTS AND METHODS: Since April 2003 to August 2004, we have performed partial splenectomy with the aid of a Lin clamp on 5 suitable patients with symptomatic cysts. Detailed patient characteristics, operative variables, and outcomes were collected. Following surgery, they were regularly followed up every 6 months. RESULTS: All five partial splenectomies were successfully executed without any complications. The mean operating time was 75 minutes, and a mean operative blood loss of 68 ml could be achieved. With a mean follow-up of 34.4 months, no cyst recurrences were detected to date. Postoperative laboratory data, imaging studies, and clinical situations proved that the preserved splenic parenchyma maintained adequate function. CONCLUSIONS: Partial splenectomy with the aid of a Lin clamp for benign splenic cysts is a practical method with the advantages of easy application, rapid parenchymal dissection, secure hemostasis, and cost-effectiveness. With encouraging preliminary results, further application of this method to bleeding eccentric parenchymal injuries of the spleen may be warranted.