Telerehabilitation for Patients with Cancer: A Scoping Review

This study was aimed at identifying how telemedicine is used for rehabilitation of patients with cancer. An electronic literature search was conducted using the PubMed database covering January 2015 to October 2020. To be included in the review, studies had to report telerehabilitation interventions for patients with cancer. Randomized controlled trials, quasi-experimental studies, as well as feasibility and usability studies were included, and reviews were excluded. Overall, 33 eligible studies were found but only 22 were considered for inclusion. After a detailed analysis, 16 studies were included. Most of the studies concluded that telehealth systems supporting physical exercise were effective to improve function, quality of life, pain, satisfaction and muscle strength. Limitations in most of the studies included non-randomized design and limited number of subjects. We conluded that more studies are needed for stronger evidence of this type of treatment and to facilitate clinical practice in this field.

Trends in opioid analgesics sales to community pharmacies and hospitals in Italy (2000-2010)

BACKGROUND

Opioid consumption data in Italy have been widely studied. However, only aggregate data can be found in the published literature, and differences are expected by distribution setting (community pharmacies and hospitals). The aim of our paper is to analyse opioids sales trends in Italy in the decade 2000-2010, in an effort to explore such differences.

METHODS

Quarterly sales data of opioid medicinal products sold by wholesalers to both community pharmacies (retail) and to hospitals (non-retail) during the time period 2000-2010 were supplied by IMS Italy. Data were standardized using the Defined Daily Doses per day per 1000 inhabitants (DDDd/1000).

RESULTS

Opioid sales have steadily increased during the time period considered going from 1.04 DDDd/1000 in 2000 to 4.9 in 2010 (+292%). Nonetheless relevant differences can be found both by distribution setting and drug type. In particular retail sales have increased by 286 % for WHO Step II opioids and by 575% for WHO Step III drugs, while non-retail sales have increased by 48% and 263%, respectively. In 2010, fentanyl and buprenorphine transdermal patches and oxycodone are more widely prescribed than morphine, in the retail setting, with fentanyl at large in the first position. In hospitals morphine and fentanyl almost equally share the 75% of the market.

CONCLUSION

Data suggest that morphine is no more the opioid of first choice for severe pain in Italy, at least for outpatients. This is contradicting most international guidelines available in the 2000-2010 decade.

Soluble receptor for advanced glycation end products in multiple sclerosis: a potential marker of disease severity

OBJECTIVES

To compare serum levels of the receptor for advanced glycation end products (sRAGE) between multiple sclerosis (MS) patients and healthy control subjects, and to investigate whether serum sRAGE levels correlate with MS disease severity as indicated by the Kurtzke Expanded Disability Status Scale (EDSS).

METHOD

37 patients with clinical diagnosis of MS and 22 healthy control subjects were investigated in a cross-sectional study using enzyme-linked immunosorbent assays (ELISA).

RESULTS

Serum levels of sRAGE were found to be significantly lower in MS patients compared to levels in healthy controls (p = 0.005). A trend toward lower levels of serum sRAGE was observed in female MS patients compared to their male counterparts (p = 0.05). A relationship between sRAGE and EDSS, and sRAGE and rate of clinical relapse was observed (p = 0.012).

CONCLUSION

The significant reduction of sRAGE in MS patients relative to healthy controls supports the potential role for RAGE axis in MS clinical pathology. Lower levels of sRAGE may be associated with enhanced inflammatory responses. Based on these observations, further investigations into the role of sRAGE in MS clinical pathology is warranted.

Further evidence for a fourth gene causing X-linked pure spastic paraplegia

X-linked hereditary spastic paraplegias (HSPs) present with two distinct phenotypes: pure and complicated. The pure form is characterized by slowly progressive weakness and spasticity of the lower limbs, whereas the complicated forms have additional features (optic neuropathy, retinopathy, extrapyramidal disturbance, dementia, epilepsy, ataxia, ichthyosis, mental retardation, and deafness). Three X-linked loci have been identified for the complicated HSP, while mutations in the proteolipid gene (PLP) (locus SPG2) were implicated in both pure and complicated forms. The absence of identified mutations in the PLP gene in families with both complicated and pure HSP, linked to the SPG2 locus, suggests the existence of another gene in close proximity. We had previously reported a large pedigree with an X-linked form of pure HSP affecting 24 males [Zatz et al., 1976: J Med Genet 13:217-222]. Here, we present the results of linkage analysis in 19 members of this Brazilian family with markers in or near the PLP locus. Positive LOD scores were obtained with markers at the PLP locus (Zmax = 2.41 at Theta = 0); however, no mutation was found in the coding region of PLP, the intron-exon boundaries, or part of the promoter region. The possibility of a duplication of the PLP gene was also excluded. These results suggest either that there is another X-linked gene in close proximity to the PLP gene or that a novel mutation in the noncoding regions of the PLP gene may cause the disease in this family.

Mitochondrial DNA polymorphisms in Chilean aboriginal populations: implications for the peopling of the southern cone of the continent

The mitochondrial DNAs (mtDNAs) from individuals belonging to three Chilean tribes, the Mapuche, the Pehuenche, and the Yaghan, were studied both by RFLP analysis and D-loop (control region) sequencing. RFLP analysis showed that 3 individuals (1.3%) belonged to haplogroup A, 19 (8%) to haplogroup B, 102 (43%) to haplogroup C, and 113 (47.7%) to haplogroup D. Among the 73 individuals analyzed by D-loop sequencing, we observed 37 different haplotypes defined by 52 polymorphic sites. Joint analysis of data obtained by RFLP and sequencing methods demonstrated that, regardless of the method of analysis, the mtDNA haplotypes of these three contemporary South American aborigine groups clustered into four main haplogroups, in a way similar to those previously described for other Amerindians. These results further revealed the absence of haplogroup A in both the Mapuche and Yaghan as well as the absence of haplogroup B in the Yaghan. These results suggest that the people of Tierra del Fuego are related to tribes from south-central South America.

[Post exercise myalgias as presentation form of dystrophinopathy]

Cramps and myalgias are frequent presentations of many disorders whose diagnosis is generally difficult. Among the unusual causes stand the milder phenotypes of dystrophinopathies, which are caused, just as Duchenne and Becker's dystrophy, by mutations in the dystrophin gene. An 8 year-old boy presented severe muscle pain on exercise and serum rise in creatine kinase over 1000 U/l. He had normal muscle power and mild calf hypertrophy. The molecular analysis by polymerase chain reaction (PCR) of the dystrophin gene showed deletions of exons 45 to 51. Dystrophin analysis by Western blot revealed a dystrophin of reduced quantity and molecular weight. Emphasis is made to include dystrophinopathies in the differential diagnosis of myalgias and the usefulness of molecular genetic techniques in the identification of these disorders.

Brazilian family with pure autosomal dominant spastic paraplegia maps to 8q: analysis of muscle beta 1 syntrophin

The autosomal dominant hereditary spastic paraplegias (AD-HSP) are a heterogeneous group of degenerative disorders of the central motor system, characterized by progressive spasticity of the lower limbs. Five loci for pure AD-HSP have been identified to date: SPG3 at 14q, SPG4 at 2p, SPG6 at 15q, SPG8 at 8q, and more recently SPG10 at 12q. We have analyzed a Brazilian family with 16 affected individuals by pure AD-HSP who developed progressive gait disturbance with onset at age 18-26 years. Linkage analysis performed with 13 relatives (6 affected and 7 normal) excluded SPG3, SPG4, and SPG6 as candidate regions. However, positive LOD scores were obtained with markers flanking the candidate region for the SPG8 locus [maximum two point Lod score (Zmax) = 3.3 at theta = 0 for D8S1804]. In this region lies the syntrophin beta 1 gene (SNT2B1), a widely expressed dystrophin-associated protein and therefore a good positional and functional candidate for this disease. Immunohistochemical and Western Blot (WB) studies showed that the distribution, expression, and apparent molecular weight of the beta 1 syntrophin protein were comparable to those of normal control individuals. Therefore, it is unlikely that defects in this protein are related to SPG8, at least in the present family.

[Axillary lymphadenectomy and its complications]

Local and regional complications of axillary dissection are evaluated. According to other authors, the most frequent ones are infections, seroma and lymphoedema. Sentinel node biopsy can reduce the number of dissections and their complications.

[Local recurrence of breast cancer]

The Authors analyse the prognostic value of the breast cancer local recurrence which not influence survival. For this reason the surgical treatment sometime can be conservative like the first treatment.

Efficacy of high dose of recombinant alpha 2b interferon on long term response in chronic hepatitis C and cirrhosis: prospective randomized multicentre study

BACKGROUND/AIMS

The long-term response to alpha-Interferon in HCV-related chronic liver diseases is disappointing. A randomized controlled trial was conducted to investigate: 1) if doubling the standard regimen of 3 MU recombinant alpha 2b-interferon thrice weekly for one year could improve the long-term response, and 2) the efficacy of these two schedules in cirrhotic patients.

PATIENTS AND METHODS

A series of 80 anti-HCV positive patients with biopsy proven liver disease (52 chronic hepatitis and 28 cirrhosis) were randomized to receive either 3 MU or 6 MU alpha 2b-interferon.

RESULTS

Based on "intention-to-treat analysis", 38% in the 3 MU group and 53% in the 6 MU group had end-of-treatment response. After 24 months, 18% had long-term response: 5% in 3 MU group and 30% in 6 MU group (p < 0.008). HCV genotype had no influence on the response rate. Thirty-eight percent of the cirrhotics treated with 6 MU had long-term response, while none of those treated with 3 MU had long-term response (difference 38%; 95% confidence internal 10%-67%; p = 0.03). At the end of treatment, 38% of patients lost HCV-RNA. After 24 months only 19% remained HCV-RNA negative: 12 patients (31%) in the 6 MU group and 2 (6%) in the 3 MU group (p < 0.05).

CONCLUSIONS

6 MU of alpha 2b-interferon thrice weekly for 12 months is significantly better than 3 MU in inducing a long-term response and permanent loss of HCV-RNA. This result is particularly striking in the subgroup of cirrhotics.

[Seminoma and adrenogenital syndrome]

The Authors report a case of a 26 year old patient affected by adrenogenital syndrome, likely due to 21 hydroxylase defect, hermaphroditism (46XX genotype and female phenotype) and worked hyperandrogenism; moreover a hidden testis neoplasm (seminoma) was associated.

[Burkitt lymphoma]

The Authors report a case of Burkitt's lymphoma of the stomach in a patient treated ten years before for Hodgkin's lymphoma. Gastrectomy associated to chemotherapy is more effective than surgical treatment alone and avoids the risk of gastric perforation during medical treatment.

[The peripheral blood lymphocyte subpopulations in chronic anti-HCV-positive liver disease: their significance and correlation with liver function]

To evaluate the role played by the immune system in the outcome of chronic C virus infection, we studied the peripheral blood lymphocyte subsets in patients with chronic hepatitis C and the correlation with the hepatic function assessed by the lidocaine test. To this end the peripheral lymphocyte subpopulations were enumerated by flow cytometry in 36 patients we had undergone a liver biopsy, prior the interferon therapy. The patients were classified as having severe chronic hepatitis with or without cirrhosis (17 subjects = group A) and mild/moderate chronic hepatitis without cirrhosis (19 subjects = group B). Twelve patients in group A and 9 in group B underwent the lidocaine test. The mean percentages of the lymphocyte subsets were not different in the two groups and in comparison with a standard healthy population, with the exception of okdr+ lymphocytes; they were significantly increased in group A (p = 0.04). The production of the lidocaine metabolite at 30 minutes prove, significantly decreased in patients with severe hepatic disease (p = 0.02), but there is no correlation between the decline of liver function and the peripheral increase of the okdr+ lymphocytes (r = 0.1877). It is probable that the increase in okdr+ lymphocytes, due to activated T-cells, is subordinated to the persistent viremia but it is independent of histological damage.

Monoethylglycinexylidide production as a measure in predicting hepatic histology

To clarify whether monoethylglycinexylidide (MEGX) production can be useful in predicting the severity of chronic liver disease, 51 subjects were enrolled in this study: 13 mild-moderate CAH (group A), 9 severe CAH (group B), 29 cirrhosis, 18 compensated and 11 decompensated disease (group C). The patients were injected with a 1 mg/Kg lidocaine bolus i.v. and serum-sampled for MEGX values (time 15, 30 and 60 minutes), determined by TDX-immunoassay. MEGX formation was significantly different (Mann-Whitney U test) in the three groups at each time interval, especially at 30 min: group A = 70.5 +/- 9.9 ng/ml (mean +/- SD); group B = 49.7 +/- 7.2; group C = 37.2 +/- 19.5 (in A vs B, p = 0.0003; in A vs C, p < 0.0001; in B vs C, p = 0.0237). The difference between compensated and decompensated cirrhosis was always significant (p = 0.0099, 0.0005, 0.0113 respectively) but between severe CAH and compensated cirrhosis it was marginal only at 15min (p = 0.0763) and absent at 30 and 60min. At 30min MEGX values > 60 suggest mild-moderate CAH, < 40 cirrhosis, < 30 decompensated cirrhosis, between 40 and 60 severe CAH or compensated cirrhosis. We are of the opinion that the MEGX test could be utilized to predict hepatic histology.

Prophylactic sclerotherapy of high-risk esophageal varices: results of a multicentric prospective controlled trial

In this prospective, multicenter trial, 140 cirrhotic patients with no previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage were randomized to receive either sclerotherapy or conservative treatment for the prevention of first variceal bleeding. The end-points of the study were bleeding and death. Life table curves showed that prophylactic sclerotherapy significantly diminished the incidence of variceal hemorrhage (p less than 0.001) and overall mortality (p less than 0.01). Two-year cumulative bleeding rate was 18% in the sclerosis group (95% confidence interval = 10 and 31) and 57% (95% confidence interval = 40 and 72) in the control group. Two-year cumulative mortality rate was 30% (95% confidence interval = 19 and 45) in the sclerotherapy group and 56% (95% confidence interval = 39 and 72) in the controls. One patient died after hemorrhage from an ulcer secondary to sclerotherapy. Analysis by the Cox model of the factors potentially confounding or interacting with the effect of sclerotherapy suggested that sclerotherapy was more efficient in preventing first bleeding in patients with decompensated disease (Child B and C) than in those in good condition (Child A). However, the 2-year cumulative bleeding rate of untreated Child A patients was only 19%, showing how in this group the endoscopic findings were unreliable in selecting high-risk varices and explaining why after a 2-year follow-up prophylactic sclerosis did not show any benefit in such patients. We conclude that sclerotherapy can decrease the incidence of first variceal bleeding and death for a period of 2 years in cirrhotic patients with high-risk varices.

Thermographic evaluation of myocardial cooling and intraoperative control of graft patency in patients with coronary artery disease

Intraoperative thermographic evaluation of regional myocardial cooling induced by cardioplegia, in patients with coronary artery disease, was conducted in 22 cases. Pictures were obtained at the beginning of the cardiopulmonary by-pass, after general cooling and during cardioplegic infusion. Uneven myocardial cooling was observed related to the degree of coronary artery stenosis. After the distal anastomosis of the saphenous vein by-pass graft was completed, injection of cold solution in to the graft showed marked cooling of the dependent myocardium, proving the patency of the graft. In the case of internal mammary artery graft (IMA), after the anastomosis was completed, releasing the bull-dog clamp on the IMA graft, allowed a flow of relatively warm (30 degrees C) blood in the anterolateral wall of the cold (20 degrees C) heart. A warm spot appeared in the thermographic pictures, assessing the patency of the IMA graft. Thermography appears to be a useful tool during myocardial revascularization in order to assess proper myocardial cooling during cardioplegia, and to check intraoperative patency of saphenous vein graft and IMA graft. The use of a special mirror prevents interference with the surgeon's work.

[Serological indices of autoimmunity in an Italian case-load of chronic active HBsAg positive and negative hepatitis]

In South Italy chronic hepatitis is characterized by high frequency of HBsAg positivity, male prevalence and infrequent presence of clinical signs of autoimmunity. To clarify some etiologic aspects of HBsAg negative chronic hepatitis, immunofluorescent tests for ANA, AMA, SMA and for liver membrane antibody (LMA) were performed on the sera of 116 consecutive non alcoholic patients with histological pattern of chronic active hepatitis (42 HBsAg+, 35 antiHBV+ and 39 negatives for all HBV markers). ANA, AMA and SMA positivity did not differentiate the three groups of patients. LMA was detectable in the sera of a relatively few number of cases; no difference was found between HBsAg positive and negative patients (21% and 18% respectively). On the contrary strong association (p less than 0.0005) was found between LMA positivity and activity of the disease, as evaluated on the basis of transaminases and IgG serum levels. These results indicate that autoimmune chronic hepatitis is rare in our geographical area and they suggest that LMA positivity is not a specific test of autoimmune liver diseases.

Telethermographic aspects of the dorsolumbar region in idiopathic scoliosis

Thermography registers thermal radiations emitted by a body on the infrared frequency. It has recently been used increasingly in medicine for the study of the thermal distribution of the skin coating. This study was carried out on 66 patients with idiopathic scoliosis who presented different degrees of curvature in different sites. In 94% of the cases an area of thermal asymmetry was found at the level of the main curvature, evidence of a different blood supply and, therefore, of different activity of the paravertebral muscles.

[Transposition of the myocutaneous flap of the latissimus muscle of the back in reconstruction of the breast after radical mastectomy. Indications and technic studied in 2 operated cases]

For repair of radical mastectomy defects the surgical approach with the latissimus dorsi myocutaneous flap is presented. The application of this flap and complication are described. In addition 2 cases are presented illustrating a personal modification of the technics.

Left arm thermography in early and maturity onset obesity

Left-arm thermography and adipose-tissue biopsy of triceps skinfold have been performed in seven patients with obesity of early onset (EO), seven with maturity-onset obesity (MO) and seven non-obese control subjects (C). Obese patients were within the same range for age, physical activity, excess body-fat content and skinfold thickness; mean fat-cell diameter was found to be significantly higher in the group MO than either EO (P less than 0.05) or C subjects (P less than 0.01). Colour thermograms, as evaluated by a well-standardized score system, showed that skin temperature was higher in MO than in EO or C cases (P less than 0.05). The combination of fat-cell hyperplasia and lower thermal losses from the skin, indicative of a lower rate of energy expenditure, may explain the higher frequency of therapeutically refractory cases in EO than MO patients.