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Health-related quality of life (HRQOL) is an important indicator of treatment effectiveness. An unhealthy lifestyle can have a negative impact on quality of life. This study aimed to investigate changes in health-related lifestyle over time after surgery for colorectal cancer and their impact on HRQOL. Healthy lifestyle habits examined in this study included physical activity, smoking, alcohol consumption, fruit and vegetable intake, sleep, and obesity levels. An observational study design was used. A total of 75 post-operative colorectal cancer patients were recruited from two medical centers in Taiwan. Data were collected through structured questionnaires. Mean HRQOL scores at 1, 3, and 5 months after discharge were 102.5 (SD = 18.8), 102.9 (SD = 20.1), and 103.0 (SD = 18.9), respectively. A generalized estimating equation analysis showed that alcohol consumption (p = 0.009), fruit and vegetable intake (p = 0.020), physical activity (p = 0.023), sleep quality (p < 0.001), and obesity (p = 0.035) were important predictors of post-operative quality of life in patients with colorectal cancer. The impact of smoking on HRQOL did not reach statistical significance. Colorectal cancer patients tend to have better HRQOL after surgery if they stay physically active, eat enough fruits and vegetables, and sleep well.

Summary: Spasticity is a common condition in stroke survivors, and may be associated with pain and joint contracture, leading to poor quality of life and increased caregiver burden. Although the underlying mechanisms are not well-understood, it may be due to disruption of the balance of supra-spinal inhibitory and excitatory sensory inputs directed to the spinal cord, leading to a state of disinhibition of the stretch reflex. The treatment options include physical therapy, modality and pharmacological treatments, neurolysis with phenol and botulinum toxin, and surgical treatment. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, natural history, and impact on patient's performances. This review focuses on the epidemiology, presumed mechanism, clinical manifestation, and recent evidences of management. Keywords: stroke, muscle spasticity, mechanism, symptom management

Summary: Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke, which may affect up to one third of stroke survivors. Unlike physical disability after stroke, cognitive function usually worsens over time and are often overlooked with detrimental impacts on the quality of life of survivors. The risk factors for post-stroke dementia are multifactorial and includes genetic predisposition, demographic factors (like older age and lower education status), pre-stroke cognitive and functional status, prior transient ischemic attack or stroke, vascular risk factors, characteristics and medical diseases associated with complications of stroke. Neuroimaging determinants are global cerebral atrophy or regional atrophy like hippocampal atrophy or medial temporal lobe atrophy, white matter lesions and changes, silent infarcts, lacunar infarcts and microbleeds. The mechanism of post-stroke dementia remains unknown and its neuropathology is poorly defined. Post-stroke dementia patients may benefit from target treatment of dementia with anti-dementia drugs as well as prevention and treatment of strokes. This review focus on the epidemiology, presumed mechanisms, recent studies on biomarkers, diagnostic workup and promising management strategies with functional outcome for post-stroke dementia. Keywords: dementia, mechanism, risk factors, stroke, treatment

Background: Falls among the elderly is a major public health concern. Tai Chi exercise appears to prevent the risk of falls among the elderly. Previous reviews found that there is insufficient evidence to conclude whether Tai Chi is effective in fall prevention. Our review was performed to update the current evidence on the effect of this intervention. Methods: We systematically searched Medline, PubMed, Embase, and Cochrane Library for studies published up to 2013. Randomized controlled trials that examined the effect of Tai Chi exercise on fall reduction were included. The quality of included studies was assessed using the Physiotherapy Evidence Database scale. Random effects meta-analysis was performed. Results: Ten trials involving 2850 participants were eligible for meta-analysis. Compared with the control group, Tai Chi exercise showed a significant reduced risk of falls (odds ratio=0.70; 95% confidence interval, 0.59 to 0.84). Subgroup analysis found no evidence of differential effects by training duration or Tai Chi style. Conclusion: Our findings demonstrate that Tai Chi exercise has a significant protective effect on fall risk among older adults. Further studies are warranted to develop optimal Tai Chi training programs (training intensity, duration, and frequency, etc.) for older adults.

Background: Self-rated health (SRH) is known to be a valid indicator for the prediction of mortality among middle-aged and older adults, but findings regarding age and gender differences are inconsistent. This study aimed to determine the association of SRH with subsequent mortality risk among middle-aged and elderly people in Taiwan. Methods: This study was based on data from the “Taiwan Longitudinal Survey on Aging” (TLSA). A total of 2553 men and 2192 women aged≥50 years of age comprised the major analytic cohort (mean age, 66.8±9.1 years). SRH was categorized into good, fair, and poor health. Cox regression methods were used to examine the association between SRH and mortality. Results: During the follow-up period (median: 10.1 years), 1644 deaths occurred. Participants with poor SRH were at higher risk of mortality [relative risk (RR), 1.35 95% confidence interval (CI), 1.16–1.55)] than those with good SRH. This SRH-mortality association was more pronounced among men (RR, 1.56, 95% CI, 1.30–1.87) than women (RR, 1.01, 95% CI, 0.80–1.27). The associations decreased with increasing age. The SRH-mortality associations were significant for the oldest age group among men, but among women, there was no significant SRH-mortality association across all age groups. Conclusion: Low SRH was associated with increased risk of mortality among middle-aged and older adults. The association varied across different age and gender groups. The association was strongest in the group of men aged 50–59 years. The factors that might explain the differences in the associations warrant further research.

Cardiovascular disease (CVD) represents a leading cause of mortality and morbidity especially among the elder people, and therefore the need of effective preventive strategies is imperative. Despite limited data among the elderly people, the majority of published studies have demonstrated that physically active elderly people have lower rates of CVD. In this article, we provide an overview of the epidemiology studies that investigate this association and analyze the relevant underlying biological mechanisms. We also discuss the types and amounts of physical activity recommended for the primary prevention of CVD in older adults.

Significant progress in our understanding of risk factors and interventions in heart failure, a leading cause of death and disability, has occurred in recent years. Several advances in therapy for heart failure with reduced left ventricular systolic function (i.e., systolic heart failure) have led to significantly improved outcomes. Treatment options for diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), by contrast, remain comparatively limited. In part, this is due to gaps in our understanding of the underlying pathophysiology and the lack of standardized criteria for its diagnosis and classification. Aging and hypertension remain the leading causes of HFpEF; increased ventricular and vascular stiffness is a feature of both. Comorbidities such as diabetes, renal insufficiency, and metabolic abnormalities further aggravate disease process, and data regarding effective treatment are lacking. This article discusses the risks, mechanisms, and outcomes of HFpEF from previous studies, and summarizes potential interventions that may provide new insights into our understanding of the disease and its treatment.

Background: Functional status is an important component of health status of the elderly. However, few studies have discussed the correlation between health status and each item of the activities of daily living scales (ADLs). The aim of this study was to investigate both the prevalence of functional disability in each activity of daily living (ADL) item and the association between each ADL item and the self-rated health of the elderly. Methods: A stratified random sample of 302 male and 298 female elderly residents, aged 65 and older, in Miaoli County was drawn. Baseline characteristics, functional status of each ADL item, and self-rated health of the participants were collected. Results: The results showed that the self-rated health status was excellent, good, or fair in 72.3% of the sample, and bad or poor in 27.7%. The most common disability among basic ADLs was transfers (9.3%); the most common disability among instrumental ADLs (IADLs) was transportation (24.7%). Multiple logistic regression analysis revealed that bathing, feeding, dressing, bowel and bladder control, transfers, transportation, and responsibility for own medication, were independently associated factors of self-rated health. Bowel and bladder control (odds ratio, 4.72; 95% confidence interval, 1.76–12.67) and feeding (odds ratio, 4.27; 95% confidence interval, 1.61–11.37) were the leading items correlated with self-rated health. Conclusion: In summary, in terms of self-rated health, the most important ADLs were bowel and bladder control and feeding. Further study is warranted to investigate the effects of restoring specific health-related ADL to improve the health of the elderly.

Traditionally, chronic heart failure (CHF) subjects are often recommended to rest and restrict physical activity; however, this advice may exacerbate the disease. Exercise training is associated with many central and peripheral adaptations that improve clinical outcomes. Exercise training can restore the abnormal autonomic function, attenuate the production of proinflammatory cytokines and the N-terminal precursor of brain natriuretic peptide (NT-pro-BNP), and improve the endothelial dysfunction and the oxidative capacity of peripheral muscle. The current evidence supports the concept that exercise training can effectively improve the exercise capacity and quality of life of subjects with CHF, to some extent, as well as reduce hospitalization and risk of mortality. Structured exercise training is proved to be safe for CHF subjects. Exercise training had no detrimental effects on the left ventricular remodeling. Ultimately, trained subjects showed a significant improvement in left ventricle function. An important limitation of current published studies is that only a few have included significant proportions of elderly subjects with CHF. The limited data available suggests that elderly subjects derive similar benefits from exercise training as younger subjects. In summary, exercise training is an inexpensive and effective intervention for subjects with CHF. This article reviews the current knowledge of the effects of exercise training on the exercise capacity, quality of life, and mortality and morbidity of subjects with CHF and elderly subjects. A major challenge for the future is the inclusion of representative proportions of elderly and frail subjects in heart failure training trials.

This article reports the difference between neuralgic amyotrophy and neuropathy caused by chemotherapy and radiation treatment which manifested with severe shoulder pain followed by marked weakness of bilateral upper arms and involvement of cranial nerves. A 62-year-old man presented with acute severe neuropathic pain at the left shoulder, bilateral shoulder weakness, hoarseness of voice from vocal cord palsy, and respiratory insufficiency from left diaphragm palsy, which all occurred sequentially over a 1-month period. The diagnosis of neuralgic amyotrophy was supported and differentiated from tumor-induced and radiation-induced neuropathy by clinical presentation, electrophysiologic and imaging studies. Unlike previous reports of the onset of neuralgic amyotrophy being associated with initiation of radiation treatment in cancer patients, this report demonstrates that neuralgic amyotrophy can occur at any point of the malignant disease process after radiation and chemotherapy.

Knee osteoarthritis (KOA) is the most common form of arthritis and one of the leading causes of disability. OA is characterized by cartilage damage, subchondral bone changes, and synovial tissue inflammation, with clinical symptoms of pain, decreased range of motion (ROM) and functional impairment. Recently, extracorporeal shockwave therapy (ESWT) has been introduced in the treatment of OA and there is increasing evidence of the therapeutic effects of ESWT on patients with KOA. For decades, there have been multiple attempts to understand the mechanisms of these therapeutic effects. So far, it is appreciated that cellular mechanotransduction through the cytoskeleton into the nuclei can regulate gene expression and cause biological changes. The purpose of this article is to provide current evidence on the physical and biological principles, mechanism of action and clinical efficacy of ESWT on KOA. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of equivalent doses in two different volumes of botulinum toxin type A (Dysport) on gastrocnemius spasticity. Design: Single-blind, randomized, controlled trial. Setting: Hospital rehabilitation department Subjects: Twenty-two children with spastic diplegic or quadriplegic cerebral palsy. Intervention: High (500 U/5 mL) and low (500 U/1 mL)-volume preparations of Dysport were injected into the gastrocnemius muscles, each child randomly receiving one preparation in the right and the other in the left leg. Main measures: Dynamic ankle joint range of motion (ROM), passive ROM of the ankle joint, modified Ashworth Scale scores, and the areas of the compound muscle action potential assessed before treatment and at four and eight weeks post treatment. Results: Both legs improved significantly. The mean (SD) improvements between baseline and the end of follow-up were 19.7 (10.83) degrees for dynamic ROM, 8.4 (9.19) degrees for passive ROM, -1.3 (0.6) for modified Ashworth Scale scores, and -9.4 (11.41) mV-ms for compound muscle action potential in the high-volume group; and 13.5 (10.45) degrees for dynamic ROM, 7.4 (7.88) for passive ROM, -0.9 (0.5) for modified Ashworth Scale scores, and -5.9 (7.50) mV-ms for areas of compound muscle action potential in the low-volume group. The high-volume preparation yielded significantly greater improvement in dynamic ROM (P<0.001), muscle tone (P<0.001), and lower compound muscle action potential area (P=0.006). Conclusions: A high-volume preparation of Dysport is more effective than a low volume in reducing spasticity in the gastrocnemius muscle. [ABSTRACT FROM AUTHOR]