Hybrid delivery of cluster-set resistance training for individuals previously treated for lung cancer: the results of a single-arm feasibility trial.

BACKGROUND: Individuals with non-small cell lung cancer (NSCLC) are burdened by long-lasting symptoms (e.g., dyspnea and fatigue) post-treatment. These symptoms often reduce physical activity levels and increase the risk of functional decline. Though we have previously proposed cluster-set resistance training to mitigate symptom burden in lung cancer, there is currently no data on the feasibility or acceptability of this mode of exercise in cancer. Therefore, the purpose of this study was to investigate the feasibility and acceptability of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC stages I-III (i.e., early stage). METHODS: This study aimed to recruit individuals with NSCLC stages I-III post-treatment to participate in 8 weeks of home-based resistance training, 3 days per week. The program included supervised sessions in the participants' homes and virtual supervision via videoconferencing. The primary outcome measure of feasibility was evaluated through recruitment, retention, and intervention fidelity (i.e., proportion of exercise completed, relative to what was prescribed). Intervention acceptability (i.e., ease and quality of virtual delivery, level of difficulty, and home-based approach) was assessed using a 4-point Likert-type scale from "strongly disagree" to "strongly agree". RESULTS: Fourteen participants were recruited over a 6-month period, with 11 completing the intervention (2 withdrew due to unrelated illness, 1 withdrew due to requiring active treatment), yielding a retention rate of 79%. Characteristics of the participants who completed the intervention (n = 11) were as follows: mean age: 71 ± 10 years, mean BMI: 29.1 ± 6.5, and average time since diagnosis was 62 ± 51 months. Of completers, 27% were male, and 36% were Black; 10 were stage I (91%), and one was stage II (9%). Mean session attendance was 86.4 ± 9.5%. Mean intervention fidelity was 83.1 ± 13.1%. With regard to acceptability, > 90% of participants positively rated all aspects of the intervention delivery. No adverse events related to exercise were recorded. CONCLUSIONS: The hybrid delivery of a home-based resistance exercise program for individuals previously treated for early-stage NSCLC was found to be safe and feasible. Adaptations to the program for future interventions are required, particularly surrounding resistance exercise programming, and intervention delivery with home visits. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05014035 . Registered January 20, 2021.

Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer.

BACKGROUND: Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. METHODS: Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants' home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. DISCUSSION: This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. TRIAL REGISTRATION: Record not yet public.

Episodic secretion of human chorionic gonadotropin in early pregnancy.

The serum concentration of human chorionic gonadotropin (hCG) was measured at 10- to 60-minute intervals for 4-24 hours in 5 women at 5-8 weeks of pregnancy. hCG was found to be secreted episodically with pulses observed every 2-4 hours. The episodic secretion of hCG may have important implications to our understanding of both normal and abnormal reproduction.

Growth-factor content of benign and malignant ovaries - a comparison.

Epidermal growth factor (EGF) and transforming growth factor alpha (TGFalpha) were estimated in extracts of 193 malignant ovarian samples, 42 benign ovarian samples and 71 normal ovaries. TGFalpha was present in 87% of malignant ovaries, 85.7% of benign ovarian tumours and 85.9% of normal ovaries. EGF was present in 30% of malignant ovaries, 35.7% of benign ovarian tumours and 12.7% of normal ovaries. TGFalpha was significantly elevated in both the malignant ovarian and benign ovarian extracts compared to normal ovaries. The median values for EGF was significantly elevated in the benign ovarian group compared to extracts from both malignant and normal ovaries.

Epidermal growth-factor receptor expression in malignant ovary, benign ovarian-tumors and normal ovary - a comparison.

Epidermal growth factor receptor (EGFR) was assayed and compared in malignant ovaries, benign ovarian tumours and normal ovaries. The EGFR was present in 39.7% of malignant ovaries, 13.3% of benign ovarian tumours and in 15.4% of normal ovaries. In the malignant group 36 samples had a low affinity component, 27 had a high affinity component and 16 had both high and low affinity components. The benign ovarian group had 1 high affinity and 3 low affinity components while the normal ovaries had 3 high affinity and 5 low affinity components. The sensitivity of the EGFR assay was 39.7% and the specificity 85.4%.

Changes in calciotrophic hormones and biochemical markers of bone turnover in normal human pregnancy.

Plasma concentrations of parathyroid hormone-related protein (PTHrP), parathyroid hormone, alkaline phosphatase, osteocalcin and albumin-adjusted calcium were measured along with nephrogenous cyclic adenosine monophosphate (NcAMP) in 10 normal women longitudinally through pregnancy. In addition, an assessment of bone resorption was made in these same subjects by the measurement in true fasting urine specimens of the calcium/creatinine ratio (Ca/Cr), hydroxyproline/creatinine ratio (HP/Cr), pyridinoline/creatinine ratio (Pyr/Cr) and deoxypyridinoline/creatine ratio (Dpyr/Cr). The PTHrP level rose through pregnancy from (mean +/- SEM) 0.8 +/- 0.2 pmol/l in the first trimester to 2.7 +/- 0.2 pmol/l 6 weeks postpartum (p < 0.0001). Serum alkaline phosphatase rose from 94 +/- 8 U/l (first trimester) to 347 +/- 25 U/l at term (p < 0.0001). A significant positive correlation was evident between PTHrP and alkaline phosphatase up to term (r = 0.44, p < 0.005). Parathyroid hormone concentrations remained unchanged during pregnancy but rose significantly postpartum from 1.8 +/- 0.2 pmol/l (first trimester) to 3.1 +/- 0.5 pmol/l (p < 0.0001). Similarly, osteocalcin, a marker of bone formative activity, remained unchanged through pregnancy but rose significantly at 6 weeks after delivery to 0.38 +/- 0.05 nmol/l from 0.19 +/- 0.03 nmol/l (first trimester) (p = 0.019). No significant change was noted in serum-adjusted calcium or NcAMP, either through pregnancy or at the postpartum assessment. Fasting urinary Ca/Cr fell through pregnancy from 0.70 +/- 0.11 (first trimester) to a nadir of 0.19 +/- 0.04 6 weeks postpartum (p = 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal breathing movements and the diagnosis of labor: a prospective analysis of 100 cases.

One hundred patients self-admitted to the hospital with a diagnosis of labor, were observed for up to 45 minutes with real-time ultrasonography to determine if the presence or absence of fetal breathing movements was helpful in separating false labor from true labor. Fetal breathing movements were not detected in 31 patients, and 30 of these delivered spontaneously within 48 hours; fetal breathing movements were present in 69 cases, and pregnancy continued for at least 48 hours in 56; of the remaining 13, labor occurred spontaneously within 48 hours in eight, whereas five had labor induced. Assessment of the cervix by Bishop score after ultrasound further improved diagnostic precision; none of 13 patients with a score greater than 9 exhibited fetal breathing movements, and all delivered within 48 hours. Gestational age did not influence outcome; 25 patients were preterm, and all 22 in whom fetal breathing movements were present continued for more than 48 hours. The results suggest that the absence of fetal breathing movements differentiates true labor from false labor.

Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding--a double-blind randomized control study.

Dysfunctional uterine bleeding results from disruption of the normal sequence of ovarian cyclic hormonal stimulation of the uterine endometrium. Treatment of dysfunctional uterine bleeding previously consisted of surgical or hormonal manipulation, or both. The present study was conducted on 34 patients in a randomized double-blind fashion to evaluate the efficacy of treating dysfunctional uterine bleeding with intravenous Premarin. Bleeding stopped in 72% of patients who received intravenous Premarin and in 38% who received placebo (P = .021). Premarin was effective in terminating endometrial bleeding in patients with biopsy-proved pathology consisting of secretory, proliferative, menstrual, polypoid, or cystic hyperplasia, as well as endometritis.

A comparison of biochemical and immunohistochemical assessment of EGFR expression in ovarian cancer.

The presence of epidermal growth factor receptor (EGFR) was determined both by immunohistochemistry and ligand binding assay in 118 samples from 96 cases of ovarian cancer. EGFR was present in 47.5% of tumours biochemically and in 39.8% of tumours analysed immunohistochemically. The concordance rate for the techniques varied between 40% in endometrioid carcinomas to 85.7% in undifferentiated carcinomas with an overall concordance of 69.5% (p < 0.001). There was no significant difference between the presence of the high, low or high plus low affinity receptor components and tumour immunoreactivity. Although the ligand binding assay is more sensitive than immunohistochemistry for detecting the epidermal growth factor receptor, some cases are positive only on immunohistochemical screening. We would recommend that both techniques should be performed in prospective studies in order to elucidate the role of EGFR expression in ovarian cancer.

Posterior choanal atresia: a syndromal disorder.

Posterior choanal atresia has a significant incidence of associated defects. Recently a constellation of defects, bearing the acronym of CHARGE, has been described. Its entities are (ocular) Coloboma, Heart defects, Atresia choanae, Retarded growth and development, Genital hypoplasia and Ear anomalies or hearing loss. Some of these have been previously noted. There are 26 patients in this series, none having the entire CHARGE association, but 7 had several; 3 of the 7 had bilateral choanal atresia. One other patient had a chromosomal defect with an associated heart defect. Two patients had cardiac and other visceral defects. Seven had base of skull abnormalities, 3 of whom had elements of CHARGE, and 9 had congenital hearing loss. Five were normal. CT scan suggests a growth disturbance of the basicranium in some of the patients.

Growth factor content in normal and benign ovarian tumours.

Epidermal growth factor (EGF) and transforming growth factor alpha (TGF alpha) content was measured in normal ovaries and benign ovarian tumours. Epidermal growth factor was present in 12.7% of normal ovaries, with a range 0.030-0.533 ng/mg DNA, and in 31.8% of benign ovarian tumours, with a range 0.1335-2.080 ng/ml DNA. TGF alpha was present in 84.5% of normal ovaries, with a range of values from 0.037-18.2 ng/mg DNA, and in 84.1% of benign ovarian tumours, with a range of 0.083-195 ng/mg DNA. The TGF alpha content in post menopausal benign ovarian tumours was significantly higher (P < 0.0001) than TGF alpha in the pre-menopausal normal ovarian group. The frequency of detection and levels of TGF alpha measured were significantly higher than those of EGF in the normal ovary group (P < 0.001) and also in the benign ovarian group (P < 0.005). We conclude that TGF alpha is the predominant growth factor present in normal ovaries and benign ovarian tumours.

Epidermal growth factor receptor in normal ovaries and benign ovarian tumours.

Epidermal growth factor receptor (EGFR) was assayed in 52 women who had normal ovaries removed at hysterectomy and in 30 women with benign ovarian tumours. The histology of each ovary was recorded. A single point screen was performed on all samples and in positive cases a full Scatchard analysis. EGFR was present in 8 of 52 normal ovaries (15.4%) and 3 contained the high-affinity component while 5 had the low affinity component. In the benign ovarian tumour group 4 of 30 tumours (13.3%) had receptor present, one was high affinity and 3 were low affinity in type. We can conclude that EGFR is detectable only at low frequency in normal and benign ovarian tumours.

Idiopathic myoglobinuria in the early puerperium.

Myoglobinuria is rare in association with pregnancy. We report a case of idiopathic myoglobinuria in the early puerperium in a patient who had a spontaneous vaginal delivery. Acute muscular pain and port wine staining of the urine should alert the clinician.

Observed characteristics of suicidal hangings: an 11-year retrospective review.

Many studies have been published regarding suicidal hanging deaths, and most forensic pathologists and coroners are very familiar with such causes of death. Forensic pathologists are challenged over their rulings regarding manner of death in part because the general public has a limited scope of knowledge. One such challenge centers on the question of whether a hanging can be a suicide if the individual is not fully suspended. The authors designed a retrospective study to review suspension in hangings and to analyze other criteria used to help in deciding manner of death. We examined 229 suicidal hanging deaths over an 11-year period (1997 through early 2009) using the data from two separate jurisdictions in Ohio. In conclusion, we found that the vast majority (83.4%) of people who hanged themselves were found partially suspended. Among other criteria analyzed, only the presence of petechial hemorrhages and acute neck injury was statistically significant.

Recurrent retropharyngeal abscess.

An infant had a case of recurrent retropharyngeal abscess. This clinical entity usually follows an upper respiratory tract infection with involvement of the retropharyngeal lymph nodes. Management includes incision and drainage as the patient's clinical status dictates and may require long-term intravenous antibiotic therapy. A biopsy of the abscess wall, assessment of the patient's immunocompetence, and a search for contributory anatomic defects may be useful. A computed tomographic scan is a valuable technique for diagnosis and follow-up.

Immunocytochemical staining of ovarian tumours with Ov632.

Ov632 monoclonal antibody, said to be highly specific for ovarian tumour tissue, was used to stain ovarian tumour cells in a variety of specimens to determine its sensitivity. Thirteen of the 41 samples investigated were negative suggesting a low sensitivity for Ov632.

Salivary gland tumors of the lip.

The UCLA experience with minor salivary gland tumors of the lip is presented and contrasted with that of the literature. The incidence of benign to malignant tumors of the lip does not follow the inverse relationship stated in the axiom that the smaller the salivary gland the greater the probability that a developing tumor will be malignant. Benign tumors represent over 80% of all salivary gland tumors of the lip. There is no preponderant malignant tumor for the lip. Adenoid cystic carcinoma, mucoepidermoid carcinoma, and adenocarcinoma occur with almost equal frequency. Because of the indolent nature of these tumors, excellent survival rates can be achieved with wide local excision with few recurrences, if the tumors are adequately treated when first seen.