Search

Liver cancer is one of the most common cancers, accounting for the sixth-highest number of new cases and the third-highest number of deaths. Sorafenib is a well-known targeted therapy for the treatment of liver cancer. Sorafenib's therapeutic use has also been linked to side effects such as diarrhea, hypertension, and skin toxicity. As a result, combining Sorafenib with other therapeutic agents is required to avoid unwanted side effects. In this study, we tried to test the combination effect of Sorafenib and Curcuma aromatica extract. The cytotoxic, migration, and colony assays were used to investigate the conjugated effect of C. aromatica extract and Sorafenib on liver cancer cell growth inhibition. At the same Sorafenib concentration, the more C. aromatica extract supplemented, the higher the cell death rate, with a statistically significant difference. To assess the relative potency of the combination, an isobologram model integrated into the CalcuSyn software was used. All of the data points were located in a synergistic area below the additive line, according to the schematic isobologram and CI distribution chart. The results indicated that the effect of sorafenib and C. aromatica was synergistic. C. aromatica extract could be used to help treat liver cancer when used with sorafenib.

Skeletal muscle dysfunction is an important systemic consequence of chronic obstructive pulmonary disease (COPD) that worsens the natural cause of the disease. Up to a third of all people with COPD ...

"Chronic obstructive pulmonary disease (COPD) is often accompanied by extrapulmonary manifestations such as limb muscle dysfunction. This term encompasses several features, including atrophy, weakness, and reduced oxidative capacity. Clinicians should become accustomed with this manifestation of COPD because of its relevance for important outcomes such as exercise tolerance and survival. Measuring muscle strength and mass can be performed with simple and valid tools that could be implemented in clinical practice. One identified, limb muscle dysfunction is amenable to therapy such as exercise training that has been repeatedly shown to improve muscle mass, strength, and oxidative capacity in COPD."

"Chronic obstructive pulmonary disease (COPD) is often accompanied by extrapulmonary manifestations such as limb muscle dysfunction. This term encompasses several features, including atrophy, weakness, and reduced oxidative capacity. Clinicians should become accustomed with this manifestation of COPD because of its relevance for important outcomes such as exercise tolerance and survival. Measuring muscle strength and mass can be performed with simple and valid tools that could be implemented in clinical practice. One identified, limb muscle dysfunction is amenable to therapy such as exercise training that has been repeatedly shown to improve muscle mass, strength, and oxidative capacity in COPD."

Even though chronic obstructive pulmonary disease (COPD) is primarily a disease of the respiratory system, limb muscle dysfunction characterized by muscle weakness, reduced muscle endurance and higher muscle fatigability, is a common secondary consequence and a major systemic manifestation of the disease. Muscle dysfunction is especially relevant in COPD because it is related to important clinical outcomes such as mortality, quality of life and exercise intolerance, independently of lung function impairment. Thus, improving muscle function is considered an important therapeutic goal in COPD management. Pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based and comprehensive approach used to promote better self-management of the disease, minimize symptom burden, optimize functional status, and increase participation in activities of daily life. Exercise training, including cardiovascular and muscle exercises, is the cornerstone of PR and is considered the best available strategy to improve exercise tolerance and muscle function among patients with COPD. This paper addresses the various components of exercise training within PR used to improve limb muscle function in COPD, providing clinicians and health-care professionals with an overview and description of these various exercise modalities and of their effects on limb muscle function. Guidance and recommendations to help design optimal limb muscle training regimens for these patients are also presented. Keywords: COPD, Exercise, Muscle function, Limb muscle dysfunction, Pulmonary rehabilitation, Resistance training, Aerobic exercises

Introduction: In addition to impaired lung function, patients with COPD often exhibit limb muscle dysfunction and impaired functional status, negatively impacting quality of life. However, whether ...

Context: Clinical assessment of muscle strength in COPD is not routinely adopted for many reasons, including lack of standardized protocols and validation studies on simple clinical tools. Aims: To determine 1) test-retest reliability of isometric quadriceps maximal voluntary contractions (iMVC) with a fixed handheld dynamometer (iMVCHD); 2) its construct validity against computerized dynamometry (iMVCCD), and 3) relationships between iMVCHD and functional capacity. Methods: 65 patients with COPD (69±8 years old, FEV1 48±21% of predicted) were tested at 4 Canadian sites on 2 separate days. The iMVCHD was measured with the fixed dynamometer [Medup] and iMVCCD with the Biodex following standardized protocols. Functional capacity was assessed with the Short Physical Performance Battery (SPPB). Intra-class correlation coefficient (ICC2,1) and standard error of measurement (SEM) were used for reliability analyses. Construct validity and associations between iMVCHD and SPPB were analysed with Spearman correlations. Results: Mean peak values for iMVCHD and iMVCCD were, respectively, 102.7±51.6 and 105.4±45.8Nm (day 1) and 105.6±58.8 and 105.4±46.9Nm (day 2), with an ICC of 0.95 [95%CI 0.92-0.97] and a SEM of 17.7Nm for iMVCHD. Spearman’s correlation between devices was 0.88 (p Conclusion: Assessment of quadriceps iMVC using a fixed handheld dynamometer shows excellent reliability and good construct validity, which favors its clinical implementation in COPD. Factors other than isometric quadriceps muscle strength may contribute to functional capacity.

Background Quadriceps weakness is associated with poor clinical outcomes in chronic obstructive pulmonary disease (COPD). However, quadriceps isometric strength assessment has not been routinely adopted in clinical practice because of the lack of homogeneity in the devices and protocols and the lack of reliability studies. Objective The objectives of this study were to determine the test-retest reliability and the criterion validity of a commercially available handheld dynamometer for evaluating the quadriceps isometric maximal voluntary contraction (iMVCquad) using a standardized protocol and to investigate the relationship between iMVCquad and functional capacity in people with COPD. Design This was a prospective, observational, multicenter trial. Methods Participants with mild to severe COPD from 4 Canadian sites were tested on 2 separate days. Five iMVCquad measurements were obtained following a standardized procedure with a fixed handheld dynamometer (iMVCquad-HHD), and then 5 iMVCquad measurements were obtained with a computerized dynamometer (iMVCquad-CD; the gold standard). Functional capacity was assessed with the Short Physical Performance Battery. Intraclass correlation coefficients, standard errors of measurement, Bland-Altman plots, and Spearman correlation coefficients were used for analyses. Results Sixty-five participants (mean age = 69 years [SD = 8]; forced expiratory volume in 1 second = 48% of predicted value [SD = 21]) completed the study. The mean iMVCquad-HHD values on visits 1 and 2 were 102.7 (SD = 51.6) and 105.6 (SD = 58.8) N·m, respectively; the standard error of measurement was 11.4 N·m. The between-visits intraclass correlation coefficient for iMVCquad-HHD was 0.95 (95% confidence interval = 0.92–0.97), with a mean bias of 2.0 (Bland-Altman plot). There was a strong correlation between iMVCquad-HHD and iMVCquad-CD (Spearman correlation coefficient = 0.86). There was no correlation between iMVCquad-HHD and Short Physical Performance Battery total score. Limitations Participants had stable COPD with few comorbidities and were more physically active than the general population of people with COPD; results might not be applicable to patients with acute exacerbations of the disease or more comorbidities. Assessment order between handheld and computerized dynamometers has not been randomized, but analyses did not highlight any systematic bias or learning effect. Conclusions Quadriceps strength assessment can be implemented in a reliable and valid way in people with COPD using a fixed handheld dynamometer and standardized procedure. This protocol should be established in clinical practice to facilitate the assessment of muscle strength in people with COPD.

Limb muscle dysfunction is frequent in COPD and contributes to its morbidity and mortality. Limb muscle dysfunction encompasses several manifestations including muscle atrophy and weakness, susceptibility to muscle fatigue and reduced oxidative capacity and mitochondrial function. Depending on the criteria used, up to a third of patients with COPD expresses some form of muscle dysfunction, including atrophy and weakness [1]. Although the extent of muscle atrophy and weakness is greater in more advanced disease, it is important to recognize that muscle dysfunction may also occur in early disease [1, 2]. The typical patients with COPD entering a pulmonary rehabilitation program have already lost about 30% of muscle mass and strength [3]. One important aspect of limb muscle dysfunction is that it is amenable to therapy, the most effective for this problem being exercise training [4–7]. Arguably, the most perverse consequence of muscle dysfunction is its negative effect on life expectancy. Parameters such as reduced mid-thigh cross-sectional area [8], fat-free mass [9], lower quadriceps strength [10] and vastus lateralis fibre-type shift [11] are predictors of mortality in subjects with COPD. Beyond its negative impact on survival, limb muscle dysfunction also contributes to exercise intolerance in COPD and poor quality of life in this disease. For example, quadriceps strength is a strong determinant of exercise capacity [12]. Premature leg fatigue reduces the ability of bronchodilators to enhance exercise tolerance [13, 14]. The links that exist between limb muscle function and relevant clinical outcomes in COPD stress out the importance for clinicians to carefully monitor body composition and muscle function when evaluating a patient with COPD, particularly before pulmonary rehabilitation where one goal of the intervention is to improve limb muscle function.

Context: Limb muscle dysfunction is associated with diminished health-related quality of life and functional capacity in people with chronic obstructive pulmonary disease (COPD). The American Thoracic Society and European Respiratory recently stated that assessment of limb muscle function should be encouraged. Despite this, quadriceps strength assessment is not yet routinely adopted in clinical practice because of the wide range of devices and protocols. This study aimed to validate the test-retest reliability of an isometric maximal voluntary contraction (iMVC) testing protocol using the Health-Canada-approved Medup™ hand-held dynamometer. Methods: 31 patients with mild to very severe COPD (18 males/13 females; mean age 68.8±5.9 years old; mean FEV1 51.6±20.6 %predicted) from 4 Canadian sites were tested on 2 separate days. 5 quadriceps iMVC were measured following a standardized procedure using a fixed Medup™. The highest value on each visit was used for analysis. Results: The mean iMVC was respectively 107.9±47.4 and 109.5±53.6 Nm, the mean variation 0.7±11.9%, and the intra-class correlation coefficient 0.96 [95%CI 0.91-0.98, p Conclusion: The Medup™ is a reliable tool to assess iMVC in people with COPD. Standardized quadriceps strength assessment can be implemented in a reliable way across sites with a simple hand-held dynamometer. Feasibility of this testing protocol in clinical settings should be investigated.

Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability. A thorough patient-centered outcome assessment, including not only measures of lung function, exercise capacity, and health-related quality of life, but also functional capacity and performance in activities of daily life, is imperative for a comprehensive management of chronic obstructive pulmonary disease. This American Thoracic Society Seminar Series is devoted to help clinicians substantiate their choice of functional outcome measures in this population. In Part 1 of this two-part seminar series, we describe the various domains of functional status to elucidate terms and key concepts intertwined with functioning and to demonstrate the clinical relevance of assessing functional capacity in the context of activities of daily living in agreement with the International Classification of Functioning, Disability, and Health. We hope that a better understanding of the various defining components of functional status will be instrumental to healthcare providers to optimize chronic obstructive pulmonary disease evaluation and management, ultimately leading to improved quality of life of patients afflicted by this condition. This first article also serves as an introduction to Part 2 of this seminar series, in which the main functional tests available to assess upper and lower body functional capacity of these patients are discussed.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient-centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity, and health-related quality of life, but also of functional capacity in activities of daily life, are necessary. In Part 2 of this seminar series, we discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving, and climbing, as well as carrying, moving, and handling objects. We review the validity, reliability, and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences, and normative values for these functional tests.