Effectiveness of eHealth mindfulness-based interventions on cancer-related symptoms among cancer patients and survivors: A systematic review and meta-analysis.

OBJECTIVES: This review aimed to synthesize the best available evidence concerning the effectiveness of electronic health, mindfulness-based interventions (eHealth-MBIs) on anxiety, depression, mindfulness and quality of life (QoL) among cancer patients/survivors. METHODS: Published and unpublished studies were retrieved from 10 electronic databases. Two independent authors screened and selected articles, extracted data using a standardized form and appraised the studies with the Cochrane risk of bias assessment tool. Meta-analyses were performed using a random-effect model with Review Manager (REVMAN). Standardized mean differences (SMDs) were used to determine intervention effects. Narrative syntheses were conducted for studies not suitable for meta-analyses. Heterogeneity was identified through I2 and chi-square statistics. Subgroup analyses were performed based on types of controls, age groups and gender. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess overall quality. RESULTS: In total, 18 studies were included. The eHealth-MBIs improved primary outcomes of anxiety (SMD = -0.28) and depression (SMD = -0.24), among cancer patients/survivors with small effect sizes. Effects for the secondary outcomes of QoL (SMD = 0.25) and mindfulness (SMD = 0.29) were observed at short-term follow-up assessments but not at post-intervention. Overall quality was rated as low for the primary and very low for the secondary outcomes. CONCLUSION: The eHealth-MBIs can be offered as a cost-effective and accessible alternative for cancer patients and survivors in healthcare settings. Future research may further explore the effectiveness of eHealth-MBIs based on different types of MBIs, cancer types, modes of delivery and other outcomes such as stress and post-traumatic growth.

Nonoperative Management of Hallux Limitus Using a Novel Forefoot Orthosis.

Hallux limitus is among the most common arthritides of the foot and ankle, with increasing incidence in the aging population. Despite its prevalence and disease burden, treatment of the condition remains poorly understood. Many patients will fail initial conservative management, whereas controversy exists surrounding indications for and outcomes of surgery. The present study sought to examine the impact of a novel forefoot orthosis on foot function, pain, and plantar pressure distributions in patients with symptomatic hallux limitus. Nineteen adult patients completed a questionnaire consisting of the 23-item Foot Function Index and a 10-point visual analogue scale measuring pain. Standing pedobarographic maps were generated using a foot scanning system. Participants were instructed to wear the orthosis in athletic shoes for 4 weeks. Eighteen participants (94.7%) experienced improvements in foot function and pain, with 12 (63.2%) reporting complete resolution of pain at the end of the 4-week trial. Mean Foot Function Index scores improved significantly from 43.0% at baseline to 11.0% with the orthosis (p < .001). Similarly, mean visual analogue scale pain scores decreased significantly from 4.87 to 1.18 (p < .001). Pedobarographic analysis while wearing the orthosis demonstrated increased ability of participants to bear weight on the arthritic hallux metatarsophalangeal joint and restoration of physiologic stance. Compared to existing products, the device was well tolerated and did not require footwear modifications or impede normal gait. Overall, the orthosis offers an appealing solution to patients dissatisfied with existing treatment options as well as those who may be averse to or ineligible for surgery.

Controlled Nano-Bio Interface of Functional Nanoprobes for in Vivo Monitoring Enzyme Activity in Tumors.

Engineering inorganic nanoparticles with a biocompatible shell to improve their physicochemical properties is a vital step in taking advantage of their superior magnetic, optical, and photothermal properties as multifunctional molecular imaging probes for disease diagnosis and treatment. The grafting/peeling-off strategy we developed for nanoparticle surface coating can fully control the targeting capability of functional nanoprobes by changing their colloidal behaviors such as diffusion and sedimentation rates at the desired sites. We demonstrated that a cleavable coating layer initially immobilized on the surface of magnetic resonance imaging probes not only makes the nanoparticles water-soluble but also can be selectively removed by specific enzymes, thereby resulting in a significant decrease of their water solubility in an enzyme-rich environment. Upon removal of surface coating, the changes in hydrodynamic size and surface charges of nanoprobes as a result of interacting with biomolecules and proteins lead to dramatic changes in their in vivo colloidal behaviors ( i. e., slow diffusion rates, tendency to aggregate and precipitate), which were quantitatively evaluated by examining changes in their hydrodynamic sizes, magnetic properties, and count rates during the size measurement. Because the retention time of nanoprobes within the tumor tissues depends on the uptake and excretion rate of the nanoprobes through the tumors, selective activation of nanoprobes by a specific enzyme resulted in much higher tumor accumulation and longer retention time within the tumors than that of the inactive nanoprobes, which passively passed through the tumors. The imaging contrast effect of tumors using activatable nanoprobes was significantly improved over using inactive probes. Therefore, the grafting/peeling-off strategy, as a general design approach for surface modification of nanoprobes, offers a promising and highly efficient way to render the nanoparticles suitable for targeted imaging of tumors.

Synthesis, Characterization, and Biomedical Applications of a Targeted Dual-Modal Near-Infrared-II Fluorescence and Photoacoustic Imaging Nanoprobe.

Our development of multifunctional dual-modal imaging probes aims to integrate the benefits from both second near-infrared (NIR-II) fluorescence (1000-1700 nm) and photoacoustic imaging with an ultimate goal of improving overall cancer diagnosis efficacy. Herein we designed a donor-acceptor chromophore based nanoparticle (DAP) as a dual-modal image contrast agent has strong absorption in the NIR-I window and a strong fluorescence emission peak in the NIR-II region. The dual-modal DAPs composed of D-π-A-π-D-type chromophores were PEGylated through nanoprecipitation. The multifunctional DAP surface was thus available for subsequent bioconjugation of EGFR Affibody (Ac-Cys-ZEGFR:1907) to target EGFR-positive cancers. The Affibody-conjugated DAPs appeared as highly monodisperse nanoparticles (∼30 nm) with strong absorption in the NIR-I window (at ca. 680 nm) and an extremely high fluorescence in the NIR-II region (maximum peak at 1000 nm). Consequently, the Affibody-DAPs show significantly enhanced photoacoustic and NIR-II fluorescence contrast effects in both in vitro and in vivo experiments. Moreover, the Affibody-DAPs have the capability to selectively target EGFR-positive tumors in an FTC-133 subcutaneous mouse model with relatively high photoacoustic and fluorescent signals. By taking advantage of high spatial resolution and excellent temporal resolution, photoacoustic/NIR-II fluorescence imaging with targeted dual-modal contrast agents allows us to specifically image and detect various cancers and diseases in an accurate manner.

Lamotrigine for bipolar disorder: translating research into clinical practice.

Lamotrigine (Lamictal, GlaxoSmithKline) is a recently developed anticonvulsant which has been investigated for efficacy in bipolar disorder. Increasing evidence indicates that it may have a different therapeutic profile than more established first-line mood stabilizers such as lithium and valproate. In particular, evidence from well-designed trials suggests efficacy for acute management and prophylaxis of bipolar depression but not mania. However, clinically relevant drug interactions and side effects can occur with lamotrigine, including benign to serious rash. The objectives of this drug profile are to review the basic chemical and pharmacological characteristics of lamotrigine, critically examine the growing body of research literature on its clinical use in the treatment of bipolar disorder, and review the safety and tolerability of lamotrigine as well as drug interactions relevant to clinical practice. Practical recommendations regarding titration and the management of rash are offered.

Reduced febrile response to bacterial infection in anorexia nervosa patients.

OBJECTIVE: To report a reduced febrile response to bacterial infections in anorexia nervosa (AN) patients. METHOD: Four cases were obtained from a retrospective review of charts from the St. Paul's Hospital Eating Disorders Program (Vancouver, Canada). The patients had died or had been admitted to the hospital for treatment of a bacterial infection. In addition, one case was obtained from the Royal Prince Alfred Hospital (Sydney, Australia). RESULTS: All patients suffered a bacterial infection during the course of AN. None of the patients had a temperature higher than 37 degrees C during the infectious illness. DISCUSSION: The absence of fever in AN may delay the diagnosis of bacterial infection and may be a marker of an impaired immune response. Therefore, alternative methods of investigation are necessary in patients with AN suspected of having a bacterial infection.