Comparative effects of EMG-driven robot-assisted therapy versus task-oriented training on motor and daily function in patients with stroke: a randomized cross-over trial

Background Robot-assisted hand training has shown positive effects on promoting neuromuscular control. Since both robot-assisted therapy and task-oriented training are often used in post-stroke rehabilitation, we raised the question of whether two interventions engender differential effects in different domains. Methods The study was conducted using a randomized, two-period crossover design. Twenty-four chronic stroke survivors received a 12-session robot-assisted intervention followed by a 12-session task-oriented intervention or vice versa. A 1-month washout period between each intervention was implemented. Outcome measures were evaluated before the intervention, after the first 12-session intervention, and after the second 12-session intervention. Clinical assessments included Fugl-Meyer Assessment for Upper Extremity, Wolf Motor Function Test, Action Research Arm Test and Motor Activity Log. Results Our findings suggested that EMG-driven robot-assisted therapy was as effective as task-oriented training in terms of improving upper limbs functional performance in activity domain, and robot-assisted therapy was more effective in improving movement duration during functional tasks. Task-oriented training showed better improvement in body function domain and activity and participation domain, especially in improving spontaneous use of affected arm during daily activities. Conclusions Both intervention protocol had their own advantages in different domains, and robot-assisted therapy may save manpower and be considered as an alternative intervention to task-oriented training. Combining the two approaches could yield results greater than either alone, which awaits further study. Trial registration: ClinicalTrials.gov Identifier: NCT03624153. Registered on 9th August 2018, https://clinicaltrials.gov/ct2/show/NCT03624153.

Testosterone Therapy for Late-Onset Hypogonadism Improves Erectile Function: A Systematic Review and Meta-Analysis

<b><i>Introduction:</i></b> Randomized controlled trials (RCTs) of testosterone therapy (TTh) for late-onset hypogonadism are systematically reviewed and a meta-analysis to assess the efficacy of TTh in improving erectile function is performed. <b><i>Methods:</i></b> The PubMed, Cochrane Library, and Web of Science databases were searched to identify RCTs published from 2007. RCTs that assessed erectile function using the erectile function domain of the International Index of Erectile Function (IIEF-EFD) were included in the meta-analysis. <b><i>Results:</i></b> The systematic review included 18 RCTs and the meta-analysis included 6 studies that enrolled a total of 1,458 patients. The overall meta-analysis revealed that the IIEF-EFD score was significantly improved in the TTh group compared with the placebo group (mean difference 1.86; 95% confidence interval 1.01–2.72; <i>p</i> &#x3c; 0.0001). Compared with patients receiving placebo, there was a significant improvement in the IIEF-EFD of patients who received TTh using testosterone gel, those who received TTh for over 30 weeks, and those without diabetes mellitus or metabolic syndrome. <b><i>Conclusion:</i></b> TTh achieved a significant improvement in the IIEF-EFD score of hypogonadal men compared with placebo, especially in those who received testosterone gel, were treated for over 30 weeks, and had no comorbidities.

Evaluation of pelvic floor muscles and sexual function in pregnant women: cross-sectional research

The aim of this study was to evaluate pelvic floor functionality and sexual function in pregnant women. The study was characterized as a descriptive and transversal research. The population consisted of 19 pregnant women, living in Parnaíba/PI. The women's assessment instruments were the evaluation and identification form that contained sociodemographic data, clinical history, obstetric and urogynecological data; the NEW PERFECT scheme was used to assess the functionality of the pelvic floor muscles and the Female Sexual Function Index (FSFI) to assess sexual function. Mean age was 25.95 (± 3.54) years, mean pelvic floor muscle strength was 2.47 (± 1.28); resistance was 4.31 (± 2.99) seconds; the number of repetitions of the contractions maintained was 2.63 (± 1.6) times; and rapid contractions were 5.05 (± 2.87) contractions. Sexual function according to the FSFI totaled a score of 25.61. In this study, it was possible to infer important deficiencies and limitations regarding strength, coordination, control and activation of the pelvic floor muscles. As in the sexual function domain, the FSFI result indicates possible dysfunctions with an emphasis on the hypoactivity of sexual desire.

Impact of Testosterone Therapy on hypogonadal patients unresponsive to phosphodiesterase-5 inhibitors alone: A systematic review and a meta-analysis

Background Phosphodiesterase-5 inhibitors as the first-line treatment for erectile dysfunction, when patients with hypogonadism fail to respond to phosphodiesterase-5 inhibitors, the beneficial of addition testosterone therapy is a major concern for clinicians. The objective of this study was to collect and summarize the evidence that evaluated the benefit of addition testosterone therapy in hypogonadism fail to respond to phosphodiesterase-5 inhibitors. Methods Electronic literature searches of Cochrane Library, PubMed, MEDLINE and EMBASE databases were conducted up to October 2020 and included randomized controlled trials. Specifically, we were looking for papers where Erectile Function Domain Score differences between pre and post-treatment were used as the primary outcome after treatment of testosterone therapy alone, phosphodiesterase-5 inhibitors therapy alone, or a dual treatment of both testosterone therapy and phosphodiesterase-5 inhibitors. Secondary outcomes included the number of phosphodiesterase-5 inhibitors non-responders who subsequently reported a satisfactory treatment of dual treatment with testosterone therapy and phosphodiesterase-5 inhibitors. Results A total of 4 studies that met our criteria, consisting of 326 patients. The Erectile Function Domain Score was significantly higher after treatment of testosterone combine with phosphodiesterase-5 inhibitors(4.88[4.18–5.57]), phosphodiesterase-5 inhibitors with placebo(3.15[1.82–4.47]), and testosterone monotherapy (2.04[0.38–3.71]) compared with baseline. Dual treatment with testosterone and phosphodiesterase-5 inhibitors significantly improved Erectile Function Domain Score when compared with testosterone monotherapy (3.16, 95% CI: 1.79–4.53), Of 41.7% patients in the dual treatment group reported an improvement, compared to only 33.0% in phosphodiesterase-5 inhibitors treatment group. Conclusions Combination therapy of testosterone and phosphodiesterase-5 inhibitors seems most effective in men with both erectile dysfunction and hypogonadism who initial unrespond to phosphodiesterase-5 inhibitors.

Factors Influencing Quality of Life in Patients with Nasopharyngeal Cancer Based on QLICP-NA (Version 2.0)

Objective To determine the quality of life (QoL) of patients with nasopharyngeal carcinoma (NPC) and the clinical factors that influence QoL. Methods Multiple linear regression, simple and canonical correlation analyses were used to analyze the factors that affected QoL in patients with NPC. Results The QoL scores were as follows: physical function domain, 61.03±15.03; mental function domain, 60.95±15.35; social function domain, 59.17±14.16; specific module domain, 75.62±14.87; and total scale score, 66.10±97.18. Multiple linear regression analyses showed that family economic status and clinical stage of the disease are the factors affecting the overall QoL among NPC patients. The simple correlation analysis showed that the hemoglobin level had a positive correlation with physical function, social function, specific module domains, and the total score of the total scale. Canonical correlation analysis revealed a pair of statistically significant typical variables and the canonical correlation coefficient was 0.561 (P<0.05). Conclusion The indicators related to the QoL among patients with NPC included family economic status, clinical stage of the disease, red blood cell count, and albumin, total bilirubin, blood urea nitrogen, creatinine, aspartate aminotransferase, and hemoglobin levels. A focus on these indicators and implementing the corresponding treatment measures had value in improving the QoL among patients with NPC.

KUALITAS HIDUP PASIEN KANKER PAYUDARA DI RSUP DR. KARIADI SEMARANG MENGGUNAKAN KUISIONER EORTC QLQ-C30

ABSTRACT Breast cancer is the most common cancer found in women and is the dominant cancer in Indonesia. Cancer treatments such as chemotherapy can affect the quality of life of patients including physical, psychological, and social. The purpose of this study is to measure the quality of life of breast cancer patients. This research used cross sectional study design. The patient quality of life was measured using the EORTC QLQ-C30 questionnaire. The subjects of this study were breast cancer patients in RSUP Dr. Kariadi Semarang meeting the inclusion criteria. The cognitive function domain, social function, emotional function, role function, and physical function were 86,15 ± 17,82; 84,10 ± 21,13; 82,56 ± 17,72; 77,95 ± 29,77; 76,72 ± 22,95, respectively. Whereas in symptom scale group from pain, fatigue, insomnia, appetite loss, financial difficulties, nausea and vomiting, constipation, dyspnea and diarrhea were 32,82 ± 30,33; 32,65 ± 21,14; 31,79 ± 34,58; 31,79 ± 32,51; 30,77 ± 32,44; 23,59 ± 25,67; 17,95 ± 30,9; 4,62 ± 14,28; 4,10 ± 13,83, respectively. For global health status / quality of life obtained 72.18 ± 18.94. The highest score on the functional scale is the cognitive function domain and the lowest score is the physical function.On the scale of symptom the domain that has the highest score is the pain domain and the lowest score is the diarrhea domain. Keywords: quality of life, breast cancer, EORTC QLQ-C30

Tadalafil Improves Erectile Dysfunction and Quality Of Life in Men with Cirrhosis: A Randomized Placebo Controlled Trial

Background and Aims: Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis. Methods: 140 cirrhotic males with ED were randomized into tadalafil 10 mg daily (n = 70) or placebo (n = 70) for 12 weeks. ED was diagnosed if erectile function (EF) domain score was < 25 in International Index of Erectile Function (IIEF) questionnaire. Primary outcome was proportion of patients having an increase in > 5 points in EF domain of the IIEF. Results: At end of 12 weeks, more patients in tadalafil group achieved > 5 points increase in the EF domain of the IIEF as compared to the placebo group [44(62.9%) vs. 21(30%), P < 0.001]. At the end of 12 weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ- 9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional, and mental health), and the mental component summary rates as compared to placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups. Conclusions: Tadalafil therapy significantly enhanced erectile function, improved anxiety, depression and quality of life, and was well tolerated by cirrhotic men with ED. (ClinicalTrials.gov identifier number: NCT03566914; first posted date: June 25, 2018).

Transient fixation of L4 vertebra preserves lumbar motion and function in Lenke Type 5C and 6C scoliosis

This study investigated the efficacy of a novel surgical method that relies on the transient fixation of L4 in Lenke Type 5C and 6C adolescent idiopathic scoliosis. Thirty-six transient surgically treated L4 fixation patients were retrospectively evaluated. The first surgery involved mechanical correction of scoliosis; the lowest instrumented vertebra (LIV) was L4. After an average of 1.3 years (range, 0.3–3.4), the second surgery to remove transient L4 pedicle screws was performed. Radiographic parameters and SRS-22 scores were measured. Cobb’s angle, coronal balance, LIV tilting angle, and LIV coronal disc angle clearly improved after the first surgery (p < 0.01). After the second surgery, the corrected Cobb angle (p = 0.446) and coronal balance were maintained (p = 0.271). Although L3/S1 lumbar lordosis decreased after the first surgery (p < 0.01), after removal of transient L4 pedicle screws, it recovered slightly (p = 0.03). Similarly, the preoperative L3/4 lateral disc mobility eventually recovered after transient L4 screw removal (p < 0.01). The function domain of the SRS-22 showed better scores after removal of transient L4 screws (p = 0.04). L4 transient fixation surgery is beneficial for Lenke Type 5C and 6C scolioses that do not fully satisfy LIV (L3) criteria. It preserves L3/4 disc motion, increases functional outcomes, and maintains spinal correction and coronal balance.

Structural Insights of Transcriptionally Active, Full-Length Androgen Receptor Coactivator Complexes

Steroid hormone receptors activate gene transcription by binding specific DNA sequences and recruiting coactivators to initiate transcription of their target genes. For most nuclear hormone receptors (NRs), the ligand-dependent activation function domain-2 (AF-2), residing in the C-terminal ligand binding domain (LBD), is a primary contributor to the NR transcriptional activity. In contrast to other steroid receptors such as estrogen receptor-α (ERα), the transcriptional activation function of androgen receptor (AR) is thought to be largely dependent on its ligand-independent activation function domain-1 (AF-1) located in its N-terminal domain (NTD). It remains unclear why AR utilizes a different activation function domain from other steroid receptors despite the fact that NRs share similar domain organizations and have a highly conserved DNA binding domain (DBD) and LBD. Here we present cryo-electron microscopic structures of DNA-bound full-length AR and its functional complex structure with its key coactivators, steroid receptor coactivator-3 (SRC-3) and the histone acetyltransferase p300. The structures reveal that androgen-bound full-length AR dimerization follows a unique head-to-head and tail-to-tail manner with all of the domains involved. The DBD and LBD are located at the center of the dimer interface. The NTDs wrap around the LBDs through their unique intra- and inter-molecular N- and C-terminal interactions and connect to each other. We observe that unlike ERα, AR binds a single SRC-3 molecule along with a single p300 molecule. The AR NTD appears to be the primary site for recruitment of both coactivators. The N-terminal region of SRC-3, rather than its receptor interaction domain, is important for this interaction. The structures presented here highlight the importance of the AR NTD for its transcriptional functions and provide a structural basis for understanding the assembly of the AR:coactivator complex and its domain contributions to transcriptional regulation.