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terventions in the postgraduate versus graduate realms.

Continuing pharmacy education (CPE) and continuing professional development (CPD) programs have been useful for enhancing the skills and performance of pharmacists. Despite its adoption worldwide, the practice of such programs has been limited in Nepal. The current pilot study aimed to assess the perception of pharmacists regarding CPE/CPD in one of the oncology centers in Nepal. The goal of this study was to provide suggestions for developing and implementing the CPE/CPD programs.

This is a cross-sectional, questionnaire-based pilot study, whereby the pharmacists and assistant pharmacists at a single-center were provided with a structured questionnaire inquiring about their perception of CPE/CPD. A mixed-method approach was followed for data collection. Descriptive statistics were used for all the variables.

A total of 15 pharmacy professionals were enrolled in the study. Recent innovations in pharmacy practices were the most commonly desired topics (n= 11, 73.3%) for CPE/CPD. Live in-person presentations (n= 10, 66.7%) and handouts method (n= 10, 66.7%) were the most recommended practices for CPE/CPD. The most commonly cited deterrent was poor quality and method of CPE delivery (n=11, 73.3%), while the most common motivation was professional competence (n= 12, 80%).

This pilot study shows the benefits of developing CPE/CPD packages in future for pharmacy professionals focusing on advances in pharmacy practices and skill development, using in-person presentations and handouts, and focusing on the curiosity of the participant to improve his/her professional practice.

This pilot study shows the benefits of developing CPE/CPD packages in future for pharmacy professionals focusing on advances in pharmacy practices and skill development, using in-person presentations and handouts, and focusing on the curiosity of the participant to improve his/her professional practice.Voiding disorders result usually from functional disturbance. However, relevant organic diseases must be excluded prior to diagnosis of functional disorders. Additional tests, such as urinalysis or abdominal ultrasound are required. Further diagnostics is necessary in the presence of alarm symptoms, such as secondary nocturnal enuresis, weak or intermittent urine flow, systemic symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in the lumbar region, altered sensations in the perineum. Functional micturition disorders were thoroughly described in 2006, and revised in 2015 by ICCS (International Children's Continence Society) and are divided into storage symptoms (increased and decreased voiding frequency, incontinence, urgency, nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency, dysuria), and symptoms that cannot be assigned to any of the above groups (voiding postponement, holding maneuvers, feeling of incomplete emptying, urinary retention, post micturition dribble, spraying of the urinary stream). Functional voiding disorders are frequently associated with constipation. Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract symptoms are accompanied by problems with defecation. Monosymptomatic enuresis is the most common voiding disorder encountered by pediatricians. It is diagnosed in children older than 5 years without any other lower urinary tract symptoms. Other types of voiding disorders such as non-monosymptomatic enuresis, overactive and underactive bladder, voiding postponement, bladder outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually require specialized diagnostics and therapy. Treatment of all types of functional voiding disorders is based on non-pharmacological recommendations (urotherapy), and such education should be implemented by primary care pediatricians.

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare neoplasm, and its clinical features and management are still limited. We evaluated the clinicopathological factors, including CDX2 immunohistochemical expression, to predict survival in patients with LCNEC.

In all, 50 patients with LCNEC who underwent surgery at 4 institutes between 2001 and 2017 were included. Clinicopathological characteristics were evaluated for prognostic factors and statistically analyzed by Kaplan-Meier curve with a log-rank test or Cox regression models. We used immunohistochemical (IHC) analysis to determine the expressions of CDX2 and compared them with clinicopathological factors and survival.

Sixteen of the 50 cases (32%) were CDX2 positive. No correlation was found between the CDX2 expression by IHC and clinicopathological factors. Multivariate analysis identified adjuvant chemotherapy (hazard ratio [HR] =2.86, 95% confidence interval [CI] = 1.04-8.16,

 = .04) and vascular invasion (HR = 4.35, 95% CI = 1.21-15.63,

 = .03) as being associated with a significantly worse rate of recurrence-free survival.

CDX2 was expressed in 1/3 of LCNEC but not associated with prognostic factor. Adjuvant chemotherapy and vascular invasion were associated with a negative prognostic factor of LCNEC.

CDX2 was expressed in 1/3 of LCNEC but not associated with prognostic factor. Adjuvant chemotherapy and vascular invasion were associated with a negative prognostic factor of LCNEC.

Exercise programs have been considered as an adjuvant treatment in obstructive sleep apnea (OSA). However, few studies have focused on the effects of the inspiratory muscle training (IMT) in reducing the severity and the symptoms of OSA.

A randomized controlled trial was conducted and approved by the local Ethics Committee. All subjects signed the informed consent form and were randomized into 2 groups a) IMT group (n = 8), 8 weeks of IMT with 75% of maximal inspiratory pressure (MIP) and b) placebo group (n = 8) subjects performed IMT without load.

IMT group showed reduction in the apnea-hypopnea index (AHI) (p = 0.01), in the Berlin questionnaire score (p = 0.001) and an increase in inspiratory muscle strength (p = 0.018). IMT group demonstrated a reduction in the AHI (31.7 ± 15.9 events/h vs 29.9 ± 15.8 events/h; p <0.001), in the Berlin questionnaire scores (2.6 ± 0.5 vs 1.2 ± 0.5; p = 0.016), Pittsburgh Sleep Quality Index (PSQI) score (7.2 ± 3.6 vs 3.7 ± 1.3; p = 0.008), in the Epworth Sleepiness Scale (ESS) (12.5 ± 4.0 vs 7.7 ± 3.0; p = 0.008) and increase in MIP (83.6 ± 26.5 cmH

O and 127.9 ± 32.5 cmH

O; p = 0.010).

The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple home-based training program and can be considered as an adjunct therapy for OSA patients.

The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple home-based training program and can be considered as an adjunct therapy for OSA patients.

To investigate the impact of eye exercises of acupoints on myopic progression among Chinese urban students.

The Beijing Myopia Progression Study (BMPS) was a three-year cohort study, with 386 students (aged 6-17 years) enrolled at baseline. These students were invited to be reexamined in the years 2011, 2012, and 2013. The student's cycloplegic refraction at each visit and the parental non-cycloplegic refraction at baseline were performed. Students were also required to complete the eye exercise of acupoints questionnaire and the convergence insufficiency symptom survey (CISS).

At the final follow-up, 226 students (57.2%) with complete refraction and eye exercises questionnaire data were enrolled in the present study. In the multivariate analysis, only students who performed the eye exercises twice or more per day had less myopic refractive change (β=0.32, p=0.04), as compared to those who performed the eye exercises less than twice per day. No significant association was found between the CISS score and the refractive change for items in the eye exercises questionnaire.

In this study cohort, the Chinese eye exercises of acupoints had a modest effect on reducing myopic progression among Chinese urban students aged 6 to 17 years. The precise mechanism remains unclear, especially in the absence of a control group.

In this study cohort, the Chinese eye exercises of acupoints had a modest effect on reducing myopic progression among Chinese urban students aged 6 to 17 years. The precise mechanism remains unclear, especially in the absence of a control group.

Perceived stress during pregnancy is associated with adverse obstetric outcomes. Antenatal perceived stress is still unaware and under-diagnosed during routine antenatal care. There has not yet been a study of prevalence and associated factors among pregnant women living in urban areas in Thailand. Understanding antenatal perceived stress is important to improve maternal and neonatal outcomes.

To identify the prevalence, associated factors, and predictive factors of perceived stress in pregnant women living in an urban area.

This cross-sectional study was conducted from December 1, 2019 to February 29, 2020 among pregnant women attending antenatal care at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand. The participants were interviewed using a structured questionnaire which included demographic data, obstetric data, serious life event data, and a Thai language version of the 10-item Perceived Stress Scale (T-PSS-10) to assess perceived stress symptomstudy demonstrated that the prevalence of perceived stress symptoms in pregnant women living in an urban area in Thailand was 23.6%. Perceived stress symptoms were significantly associated with divorce, separation from spouse, physical or psychological trauma from family, marital conflict, and family conflict. Predictive factors for perceived stress symptoms were marital conflict and family conflict.

Fatigue is a prevalent symptom affecting primary Sjögren's syndrome (pSS) patients. The purpose of this study is to determine the prevalence of fatigue in Saudi pSS patients and its correlation with disease features and outcome measures using a validated tool.

This is a cross-sectional study evaluating fatigue in pSS using the Arabic version of the fatigue severity scale (FSS). The EULAR Sjögren's syndrome disease activity index (ESSDAI) and EULAR Sjögren's syndrome patient reported index (ESSPRI) were calculated.

Forty-one patients met the sample criteria and were involved in the final report. There were predominantly females (78%) with a mean (±SD) age and disease duration of 58.76±12.7 and 4.6±2.28 years, respectively. Based on the FSS, 18 (43.9%) patients had a positive test with a mean score of 5.43±0.76. The mean ESSDAI was 9.95±7.73, while the mean EESPRI was 5.17±2.4 with individual component scores were dryness (5.23±2.62), fatigue (5.4±2.88), and pain (4.88±3.31). The FSS had a significant correlation with PGA (r=0.559;

<0.001), PhGA (r=0.671;

<0.001), ESSDAI (r=0.402;

=0.01), ESSPRI fatigue component (r=0.0.621;

<0.001), ESSPRI pain component (r=0.558;

<0.001), and missed significance for the ESSPRI dryness component (r=0.289;

=0.071). There was no correlation between the total ESSPRI score and presence of fatigue (r=-0.261;

=0.104) nor the FSS score (r=-0.136;

=0.409).

Fatigue is prevalent in Saudi pSS patients. FSS correlated with ESSDAI and ESSPRI components but not its total score signaling other unmeasured factors contributing to fatigue development.

Fatigue is prevalent in Saudi pSS patients. Napabucasin molecular weight FSS correlated with ESSDAI and ESSPRI components but not its total score signaling other unmeasured factors contributing to fatigue development.