Comparing the effects of self-management and hospital-based pulmonary rehabilitation programs in COPD patients

Background

Pulmonary rehabilitation (PR) is a core component of the management of patients with chronic obstructive pulmonary disease (COPD). Although several types of PR programs are implemented for patients with COPD on the basis of patient preferences or clinical protocols, the clinical efficiencies of these programs may vary, with each program having its own unique purpose, procedures, benefits, challenges, and effectiveness.

Aim

The aim of this study was to compare the effects of self-management and hospital-based PR programs in COPD patients.

Materials and Methods

This study was prospective intervention research. Fifty-eight patients with stable COPD were randomly allocated to a hospital-based outpatient group and a self-management group before commencement of a 12-week PR program. Before and after the PR program, all patients were evaluated using the 6-min walk test, Modified Borg Scale, St. George's Respiratory Questionnaire, State-Trait Anxiety Inventory, and Standardized Mini-Mental Test.

Results

Pulmonary functions, dyspnea, quality of life, and 6MWT distance were significantly improvement the hospital-based PR than self-management PR (P < 0.05). Moreover, cognitive function significantly improved after the PR program in both groups with no significant intergroup difference (P > 0.05).

Conclusions

Our findings suggest that PR is useful for to improvement functional capacity, quality of life, cognitive function and anxiety, in patients with COPD. A hospital-based PR is more effective than a self-management PR program.

Potential of a gypsum-free composting process of wheat straw for mushroom production

Wheat straw based composting generates a selective substrate for mushroom production. The first phase of this process requires 5 days, and a reduction in time is wished. Here, we aim at understanding the effect of gypsum on the duration of the first phase and the mechanism behind it. Hereto, the regular process with gypsum addition and the same process without gypsum were studied during a 5-day period. The compost quality was evaluated based on compost lignin composition analysed by py-GC/MS and its degradability by a commercial (hemi-)cellulolytic enzyme cocktail. The composting phase lead to the decrease of the pyrolysis products 4-vinylphenol and 4-vinylguaiacol that can be associated with p-coumarates and ferulates linking xylan and lignin. In the regular compost, the enzymatic conversion reached 32 and 39% for cellulose, and 23 and 32% for xylan after 3 and 5 days, respectively. In absence of gypsum similar values were reached after 2 and 4 days, respectively. Thus, our data show that in absence of gypsum the desired compost quality was reached 20% earlier compared to the control process.

Preoperative chemotherapy for T2 breast cancer is associated with improved surgical outcome

BACKGROUND

The aim of this study is to compare the clinical outcome in T2 breast cancer patients who underwent preoperative chemotherapy (PC) and who did not. The study also tried to define a subgroup of patients, who are more beneficial after PC in terms of lower re-excision rates, better cosmetic results and local recurrence free survival.

MATERIALS AND METHODS

251 consecutive patients treated for nonmetastatic T2 invasive breast cancer were analyzed retrospectively. Of those; 141 underwent primary surgery (PS) followed by chemotherapy, whereas 110 were treated with combination of PC and surgery.

RESULTS

The patients who were treated with PC had a significantly higher incidence of negative margins and lower rate of re-excision (5% vs. 16%, p = 0.02). Of all patients attempted breast conserving surgery (BCS), patients in the PC group were more likely to undergo BCS as their definitive operation compared to patients with PS group (BCS rates; PC group: 99% vs. PS group: 92%, p = 0.05). Multifocal disease (OR: 7, 95% Cl, 2.7-18.4, p = 0.0001) and PC (OR = 0.2; 95% CI, 0.06-0.72, p = 0.01) were factors associated with margin positivity in patients treated with BCS. There was no statistically significant difference in 5 year local-recurrence free survival rates between 2 groups.

CONCLUSIONS

Our study shows that PC significantly decreases the re-excision in patients undergoing BCS with primary T2 breast tumors. This data suggests that any patient with a tumor greater than 2 cm might be considered for PC to increase BCS success with final negative margins.

Risk factors for pelvic surgery

One hundred and eighty four women who had corrective surgery for stress incontinence, genital prolapse or both were compared with two hundred and ninety women who had no surgery for these conditions. Patients and controls did not differ in terms of age, height, weight or body mass index. Younger age at first delivery (20.1+/-4.1 vs 22.8+/-4.9, p<0.000) and a smoking history (33.2% vs 23%, p<0.015) were found as risk factors for the study group. Women who underwent surgery had greater gravidity (4.85+/-2.9 vs 3.87+/-2.5, p<0.001), greater parity (3.03+/-1.9 vs 2.19+/-1.3, p<0.000), were less often nulliparous (2.2% vs 7.9%, p<0.008), less likely to have had a cesarean delivery (1.1% vs 9%, p<0.001) and more likely to have had a vaginal delivery (97.3% vs 85.9%, p<0.000) than the control group. The study group have had larger neonates on average (3800+/-416 vs 3373+/-637 gm's, p<0.000) and had greater use of forceps or vacuum extractor for at least one delivery (17.9% vs 7.6%, p<0.001). Highly significant relationship was found between the risk of having corrective surgery and the number of children born vaginally. Women who had 4 or more vaginal deliveries had 11.7 times more risk of urinary incontinence or genital prolapse.

Influence of turkey meat on residual nitrite in cured meat products

A response surface experimental design was employed to estimate residual nitrite level at various initial nitrite concentrations, percent turkey meat in the formula, and heat quantity (F) values using a typical wiener as the test system. Pork and mechanically separated turkey were used as the meat ingredients. Residual nitrite and pH were measured at day 1, 7 days, 14 days, and 49 days after processing. Protein, fat, salt, moisture, and CIE (L*a*b*) color values were also determined. Results showed that the effect of turkey meat on residual nitrite level was significant (P < 0.01). An increased amount of turkey meat in the formula resulted in lower residual nitrite levels at a fixed pH. The residual nitrite level was initially proportional to initial nitrite concentration, but it became a nonsignificant factor during longer storage time. Differences in heat quantity had a significant effect (P < 0.05) on residual nitrite level initially. Greater heat quantity decreased residual nitrite level in finished cured meat products at a fixed pH. However, this effect became nonsignificant during longer storage. Reduction of residual nitrite in wieners because of turkey meat addition at a fixed pH was due to characteristics of the turkey tissue, but the mechanism of action remains unknown. It was also established that commercial wieners had a higher pH if poultry meat was included in the formulation.