The survival outcome in BC survivors is likely to have some correlation with exercise; long-term physical activity levels are important for BC prognosis and are associated

Objective: Lower limb amputation is common in war combat and armed conflict as well as in traumatic settings and presents a challenge for health care providers. The incorporation of advanced technologies, particularly virtual reality, presents an opportunity to address the main consequences of amputation, principally balance and gait. The aim of this study was to investigate the additional effect of virtual reality with a traditional rehabilitation exercise program on balance and gait in unilateral, traumatic lower limb amputees. Materials and Methods: Thirty-two traumatic lower limb amputees, fulfilling a postfitting rehabilitation program at least 6 months ago, were recruited and randomly assigned into two identically sized groups; group C (control group) experiencing the traditional exercise program and group VR (virtual reality group) experiencing an addition of a virtual reality training. The intervention was conducted over 6 weeks at a rate of three sessions per week. Outcome measures assessed before and after 6 weeks were the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Dynamic Gait Index (DGI), and 6-minute walk test (6 MWT). Results: Both interventions induced improvement in all measured parameters (P < 0.05); however, virtual reality demonstrated significant superior effects only on the balance markers, TUG test, DGI, and BBS (P < 0.05), but not on the 6 MWT (P > 0.05). Conclusion: Virtual reality is a promising, amusing, and safe intervention for addressing balance and gait in unilateral, traumatic lower limb amputees.

[Purpose] This study was carried out to determine the effect of an exercise program on pelvic pain and posture associated with endometriosis. [Subjects and Methods] This study was designed as repeated measures design that compared one group of 20 patients (age range 26–32 years) diagnosed by laparoscope as having mild or moderate endometriosis before, after 4 weeks, and after 8 weeks of exercise program. The exercise program parameters were based on the American College of Obstetricians and Gynecologists guidelines for exercise suitable for sedentary women. To assess the intensity of endometriosis pain, a present pain intensity scale was used. On the other hand, a raster stereography system was used to assess the posture. [Results] After 8 weeks of performing the exercise regimen, there was a statistically significant decrease in the patients’ pain intensity and thoracic kyphosis angle program in compared with pre treatment. [Conclusion] Ultimately it was proven that eight weeks of an exercise program is very effective in decreasing pain and postural abnormalities associated with endometriosis.

Background: Neratinib (HKI-272), an irreversible pan-ErbB inhibitor of the tyrosine kinase receptors ErbB1, -2 and -4, has shown antitumor activity in patients with ErbB2+ disease, with or without prior trastuzumab exposure. In preclinical models, neratinib inhibits ErbB receptor complex downstream signaling via the phosphatidyl inositol-3-kinase (PI3K) pathway. PI3K signaling activity may mediate resistance to trastuzumab and endocrine therapy in breast cancer (BC). The objective of this ongoing phase 1/2 study is to evaluate the safety and efficacy of neratinib in combination with paclitaxel in patients with solid tumors and ErbB2+ metastatic BC.Material and Methods: This open-label, 2-part study enrolled patients with solid tumors (part 1; determine the maximum tolerated dose [MTD]) and ErbB2+ advanced/metastatic BC in the first- to fourth-line setting (part 2; objective response rate [ORR] at the MTD). In part 1, patients received ascending multiple daily oral dosages of neratinib (160 mg, 240 mg) plus IV paclitaxel 80 mg/m2 on days 1, 8, and 15 of a 28-day cycle. In part 2, patients received neratinib plus paclitaxel at the MTD. Tumor response was assessed using modified RECIST criteria. Safety and pharmacokinetic (PK) parameters were also evaluated.Results: Full doses of both neratinib (240 mg) and paclitaxel (80 mg/m2) were well tolerated in part 1 and evaluated in patients with ErbB2+ BC in part 2. As of 1 May 2009, data were available for 102 patients in part 2 (median age [range], 50.5 [20.0-76.0] years; 100% were female). Treatment-emergent adverse events (TEAEs) reported in ≥10% of patients included diarrhea (89%), neutropenia (42%), rash (26%), nausea (26%), and vomiting (20%). Common grade ≥3 TEAEs included diarrhea (25%), leukopenia (20%), and neutropenia (17%). Diarrhea was generally observed early (median onset, 3 days after the first dose of neratinib; median duration, 17 days). One patient withdrew because of toxicity (renal failure, dehydration). Evaluation of preliminary PK parameters suggested no interaction between the 2 drugs; exposures were similar to those observed for each drug as monotherapy. The ORR in part 2 (complete plus partial responses) among 97 evaluable patients was 62.9% (80% confidence interval [CI], 55.9-69.4). Median progression-free survival is estimated at 40 weeks (76% of patients censored). Of 37 patients treated with prior Her2-directed therapy, 21 responded (ORR, 56.8% [80% CI, 44.9-68.0]), including 9 of 13 patients treated with prior lapatinib (ORR, 69.2% [80% CI, 47.7-85.8]). Responses were observed in 27 of 37 patients with prior endocrine therapy in any line (ORR, 73.0% [80% CI, 61.5-82.5]), and 43 of 60 patients with prior taxane treatment (ORR, 71.7% [80% CI, 62.9-79.3]).Discussion: The combination of neratinib 240 mg and paclitaxel 80 mg/m2 was tolerable, with a similar toxicity profile to each drug given as monotherapy. Although the sample size of the trial was limited, differential clinical activity was observed in ErbB2+ metastatic BC with respect to prior treatment, supporting further investigation of patient subsets in future trials. A phase 3 trial is planned to study this combination in the first-line setting compared with trastuzumab plus paclitaxel. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5081.

Background: The muscle imbalances between upper and lower trapezius muscle activity are related to abnormal scapular motion in patients with frozen shoulder. This explains the importance of rehabilitation of the lower trapezius muscle in addition to common stretching and mobilizing treatment protocols for patients with frozen shoulder. Purpose: This study aims to investigate the effect of additional strengthening exercises of lower fibers of trapezius muscle on the scapular tipping in patients with Diabetic Frozen Shoulder (DFS). Subjects and methods: Thirty patients with DFS were randomly assigned into two equal groups A and B. Both groups received a traditional physical therapy program, however group B additionally received strengthening exercises for lower fibers of trapezius. Baseline and post-treatment assessment for the scapular tipping were evaluated by using (A-T) distance test. Results: After treatment; mixed design MANOVA revealed significant improvement in scapular tipping (A-T) distance from supine position, supine position with scapula retraction, standing position, and standing position with scapula retraction, for group B more than group A (P<0.05). There were significant improvements in scapular tipping when comparing the post-treatment mean value with pretreatment in group B only (P<0.05). Conclusion: Strengthening of the lower trapezius fibers plus traditional physical therapy program yields improvement in scapular tipping in patients with DFS more than traditional physical therapy alone.