Παρασκευή, 22 Δεκεμβρίου 2017

Treatment of advanced nasopharyngeal cancer using low- or high-dose concurrent chemoradiotherapy with intensity-modulated radiotherapy: A propensity score-matched, nationwide, population-based cohort study

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Publication date: Available online 22 December 2017
Source:Radiotherapy and Oncology
Author(s): Tsung-Ming Chen, Kuan-Chou Lin, Kevin Sheng-Po Yuan, Chia-Lun Chang, Jyh-Ming Chow, Szu-Yuan Wu
BackgroundNo large-scale, head-to-head, phase III, randomized, controlled trial with an adequate sample size has investigated the effect of concurrent low-dose (LD) or high-dose (HD) cisplatin with radiotherapy on nasopharyngeal cancer (NPC). Thus, we conducted a propensity-score-matched, nationwide, population-based cohort study in Taiwan to investigate the outcomes of LD-concurrent chemoradiotherapy (CCRT) or HD-CCRT with intensity-modulated radiotherapy (IMRT) in patients with advanced NPC.MethodsIn this study, patients were categorized into 2 groups according to their chemotherapy regimen: HD-CCRT and LD-CCRT groups.ResultsWe enrolled 1968 patients (328 and 1640 in the LD-CCRT and HD-CCRT groups, respectively) who had received CCRT with IMRT. According to both univariate and multivariate Cox regression analyses, a hazard ratio (95% confidence interval) of 0.75 (0.54–1.06, P = .103) was derived for the HD-CCRT group.ConclusionLD-CCRT or HD-CCRT with IMRT can be a standard treatment that can prolong the survival of patients with advanced NPC.



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Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients

Abstract

Purpose

Coiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique.

Methods

We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months.

Results

No procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion.

Conclusion

Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.



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Apparent Diffusion Coefficient Histogram Analysis for Prediction of Prognosis in Glioblastoma

Publication date: Available online 21 December 2017
Source:Journal of Neuroradiology
Author(s): Masatoshi Kondo, Yoshikazu Uchiyama
BackgroundTo investigate the potential to predict prognosis of glioblastoma (GBM) patients by analysis of the broader and lower values in the lower distribution of apparent diffusion coefficient (ADCL) (B&L-ADCL) values in the ADC histogram.Material and methodsPresurgical publicly available diffusion-weighted images (DWI) and contrast-enhanced T1-weighted images from 76 GBM patients were analyzed. With applied 2-mixture normal distribution in the ADC histogram of enhanced lesions on T1-weighted images, the mean and width of ADCL were analyzed. We dichotomized the lower mean of ADCL (L-ADCL) and the broader width of ADCL (B-ADCL) at their own average. B&L-ADCL was defined as B-ADCL with L-ADCL. Progression-free survival (PFS) and overall survival (OS) were determined by using Cox proportional hazards analysis and the Kaplan–Meier method with the log-rank test. The difference between PFS and OS was calculated.ResultsSix (7.89%) patients had B&L-ADCL values. B&L-ADCL was strongly associated with poor PFS (hazard risk: 5.747; P = 0.002) and OS (hazard risk: 3.331; P = 0.018). There were significant differences in PFS (median, 77 vs. 302 days; P < 0.001) and OS (median, 199 vs. 472 days; P = 0.004) between the patents with and without B&L-ADCL. There was no significant difference in the OS–PFS duration difference between the patients with (median, 79 days) and without B&L-ADCL (median, 132 days) (P = 0.348).ConclusionIn this study, B&L-ADCL from pretreatment ADC analysis predicted poor PFS. B&L-ADCL may indicate higher cellularity and heterogeneity in GBM tumor tissue.



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Treatment of advanced nasopharyngeal cancer using low- or high-dose concurrent chemoradiotherapy with intensity-modulated radiotherapy: A propensity score-matched, nationwide, population-based cohort study

No large-scale, head-to-head, phase III, randomized, controlled trial with an adequate sample size has investigated the effect of concurrent low-dose (LD) or high-dose (HD) cisplatin with radiotherapy on nasopharyngeal cancer (NPC). Thus, we conducted a propensity-score-matched, nationwide, population-based cohort study in Taiwan to investigate the outcomes of LD-concurrent chemoradiotherapy (CCRT) or HD-CCRT with intensity-modulated radiotherapy (IMRT) in patients with advanced NPC.

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Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen

SBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies.

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Adapting the Caesium-137 technique to document soil redistribution rates associated with traditional cultivation practices in Haiti

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Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): H. Velasco, R. Torres Astorga, D. Joseph, J.S. Antoine, L. Mabit, A. Toloza, G. Dercon, Des E. Walling
Large-scale deforestation, intensive land use and unfavourable rainfall conditions are responsible for significant continuous degradation of the Haitian uplands. To develop soil conservation strategies, simple and cost-effective methods are needed to assess rates of soil loss from farmland in Haiti. The fallout radionuclide caesium-137 (137Cs) provides one such means of documenting medium-term soil redistribution rates. In this contribution, the authors report the first use in Haiti of 137Cs measurements to document soil redistribution rates and the associated pattern of erosion/sedimentation rates along typical hillslopes within a traditional upland Haitian farming area. The local 137Cs reference inventory, measured at an adjacent undisturbed flat area, was 670 Bq m−2 (SD = 100 Bq m−2, CV = 15%, n = 7). Within the study area, where cultivation commenced in 1992 after deforestation, three representative downslope transects were sampled. These were characterized by 137Cs inventories ranging from 190 to 2200 Bq m−2. Although, the study area was cultivated by the local farmers, the 137Cs depth distributions obtained from the area differed markedly from those expected from a cultivated area. They showed little evidence of tillage mixing within the upper part of the soil or, more particularly, of the near-uniform activities normally associated with the plough layer or cultivation horizon. They were very similar to that found at the reference site and were characterized by high 137Cs activities at the surface and much lower activities at greater depths. This situation is thought to reflect the traditional manual tillage practices which cause limited disturbance and mixing of the upper part of the soil. It precluded the use of the conversion models normally used to estimate soil redistribution rates from 137Cs measurements on cultivated soils and the Diffusion and Migration conversion model frequently used for uncultivated soils was modified for application to the cultivated soils of the study area, in order to take account of the unusual local conditions. The model was also modified to take account of the fact that cultivation in the study area commenced in 1992, rather than predating the period of weapons test fallout which extended from the mid 1950s to the 1970s. Erosion rates on the upper parts of the hillside involved in the study were found to be relatively high and ca. −23 t ha−1 y−1 with low spatial variability. In the lower, flatter areas at the bottom of the slope, deposition occurred. Deposition rates were characterized by high spatial variability, ranging from 6.0 to 71 t ha−1 y−1. Soil redistribution rates of this magnitude are a cause for concern and there is an urgent need to implement soil conservation measures to ensure the longer-term sustainability of the local agricultural practices.



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An inverse method to estimate emission rates based on nonlinear least-squares-based ensemble four-dimensional variational data assimilation with local air concentration measurements

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Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): Xiaobing Geng, Zhenghui Xie, Lijun Zhang, Mei Xu, Binghao Jia
An inverse source estimation method is proposed to reconstruct emission rates using local air concentration sampling data. It involves the nonlinear least squares-based ensemble four-dimensional variational data assimilation (NLS-4DVar) algorithm and a transfer coefficient matrix (TCM) created using FLEXPART, a Lagrangian atmospheric dispersion model. The method was tested by twin experiments and experiments with actual Cs-137 concentrations measured around the Fukushima Daiichi Nuclear Power Plant (FDNPP). Emission rates can be reconstructed sequentially with the progression of a nuclear accident, which is important in the response to a nuclear emergency. With pseudo observations generated continuously, most of the emission rates were estimated accurately, except under conditions when the wind blew off land toward the sea and at extremely slow wind speeds near the FDNPP. Because of the long duration of accidents and variability in meteorological fields, monitoring networks composed of land stations only in a local area are unable to provide enough information to support an emergency response. The errors in the estimation compared to the real observations from the FDNPP nuclear accident stemmed from a shortage of observations, lack of data control, and an inadequate atmospheric dispersion model without improvement and appropriate meteorological data. The proposed method should be developed further to meet the requirements of a nuclear emergency response.



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Editorial Board

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Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182





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Obligate Overdiagnosis Due to Mammographic Screening: A Direct Estimate for U.S. Women.

Obligate Overdiagnosis Due to Mammographic Screening: A Direct Estimate for U.S. Women.

Radiology. 2017 Dec 21;:171622

Authors: Hendrick RE

Abstract
Purpose To determine obligate overdiagnosis rates, defined as the percentage of women diagnosed with screen-detected breast cancer who die of causes other than breast cancer prior to clinical presentation of that cancer, for ductal carcinoma in situ (DCIS), invasive breast cancer, and all breast cancers. Materials and Methods Age-specific all-cause mortality rates from the Human Mortality Database, age-specific breast cancer incidence and mortality rates from Surveillance, Epidemiology, and End Results data, and estimates of mean lead times and lead time distributions from breast cancer screening trials are used to estimate obligate (or type 1) overdiagnosis rates for DCIS, invasive breast cancer, and all breast cancers (DCIS plus invasive) for U.S. women undergoing screening mammography. Mortality rates by age are used to estimate the number of women who die of causes other than breast cancer during the lead time afforded by screening mammography. Resulting age-dependent overdiagnosis rates, along with screen-detected breast cancer incidence by age, are used to estimate type 1 overdiagnosis rates for the U.S. screening population. Results Obligate overdiagnosis rates depend strongly on the age at which a woman is screened, ranging from less than 1% at age 40 years to 30%, 21%, and 22.5% at age 80 years for DCIS, invasive breast cancer, and all breast cancers, respectively. Type 1 overdiagnosis rates among screened women in the United States are estimated to be 9% for DCIS and approximately 7% for both invasive breast cancer and all breast cancers. Screening of women ages 40-49 years (or premenopausal women, as determined from patient history, starting at age 40 years) adds little to obligate overdiagnosis rates (0.15% for DCIS and less than 0.1% for invasive breast cancer and all breast cancers). Conclusion Type 1 overdiagnosis rates increase rapidly with age at screening. Obligate overdiagnosis occurs in 9% of DCIS and approximately 7% of both invasive breast cancer and all breast cancers in the U.S. mammographic screening population, with screening of women ages 40-49 years (or premenopausal women starting at age 40 years) making a negligible contribution of 0.15% to obligate overdiagnosis of DCIS and a contribution of less than 0.1% to the obligate overdiagnosis rates of invasive breast cancer and all breast cancers. © RSNA, 2017 Online supplemental material is available for this article.

PMID: 29267146 [PubMed - as supplied by publisher]



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Improving Arterial Spin Labeling by Using Deep Learning.

Improving Arterial Spin Labeling by Using Deep Learning.

Radiology. 2017 Dec 21;:171154

Authors: Kim KH, Choi SH, Park SH

Abstract
Purpose To develop a deep learning algorithm that generates arterial spin labeling (ASL) perfusion images with higher accuracy and robustness by using a smaller number of subtraction images. Materials and Methods For ASL image generation from pair-wise subtraction, we used a convolutional neural network (CNN) as a deep learning algorithm. The ground truth perfusion images were generated by averaging six or seven pairwise subtraction images acquired with (a) conventional pseudocontinuous arterial spin labeling from seven healthy subjects or (b) Hadamard-encoded pseudocontinuous ASL from 114 patients with various diseases. CNNs were trained to generate perfusion images from a smaller number (two or three) of subtraction images and evaluated by means of cross-validation. CNNs from the patient data sets were also tested on 26 separate stroke data sets. CNNs were compared with the conventional averaging method in terms of mean square error and radiologic score by using a paired t test and/or Wilcoxon signed-rank test. Results Mean square errors were approximately 40% lower than those of the conventional averaging method for the cross-validation with the healthy subjects and patients and the separate test with the patients who had experienced a stroke (P < .001). Region-of-interest analysis in stroke regions showed that cerebral blood flow maps from CNN (mean ± standard deviation, 19.7 mL per 100 g/min ± 9.7) had smaller mean square errors than those determined with the conventional averaging method (43.2 ± 29.8) (P < .001). Radiologic scoring demonstrated that CNNs suppressed noise and motion and/or segmentation artifacts better than the conventional averaging method did (P < .001). Conclusion CNNs provided superior perfusion image quality and more accurate perfusion measurement compared with those of the conventional averaging method for generation of ASL images from pair-wise subtraction images. © RSNA, 2017.

PMID: 29267145 [PubMed - as supplied by publisher]



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Low Graft Attenuation at Unenhanced CT: Association with 1-Month Mortality or Graft Failure after Liver Transplantation.

Low Graft Attenuation at Unenhanced CT: Association with 1-Month Mortality or Graft Failure after Liver Transplantation.

Radiology. 2017 Dec 21;:171144

Authors: Kim JS, Kwon JH, Kim KW, Kim SY, Choi SH, Song GW, Lee SG

Abstract
Purpose To investigate whether low graft attenuation at unenhanced computed tomography (CT) is associated with 1-month mortality or graft failure after liver transplant and determine its diagnostic performance. Materials and Methods Included were 663 recipients who underwent CT imaging within 7 days after liver transplant between December 2014 and August 2016. Initial poor function (IPF) was diagnosed by using a combination of laboratory values within 7 days after liver transplant and subdivided patients into primary and secondary IPF. At 1 month after the operation, mortality and graft failure or survival in recipients was categorized. Two radiologists who were blinded to clinical data retrospectively and independently evaluated graft attenuation on unenhanced CT images (high or isoattenuation, graft attenuation greater than or equal to that of spleen; low, graft attenuation less than that of spleen). The interobserver agreement was evaluated by using intraclass correlation coefficient and κ statics. Incidence of low graft attenuation between recipients with IPF and those with normal function was compared by using χ2 test. The relationship between graft attenuation and outcome in primary and secondary IPF was evaluated by using log-rank test. Results Of 663 recipients, 114 had IPF (80 primary; 34 secondary). After 1 month, 11 had graft failure or died, whereas 652 survived. Low graft attenuation was more common in patients with IPF than in normal-function patients (P < .001). In the primary group (those without identifiable cause), 15 patients had low graft attenuation, which led to mortality or graft failure within 1 month in seven of those patients. No recipient with high or isoattenuation had 1-month mortality or graft failure (P < .001). The secondary group (those with identifiable cause) showed no significant association between graft attenuation and 1-month mortality and graft failure (P = .181). Values of low graft attenuation for 1-month mortality and graft failure in primary IPF were positive predictive value, 46.7%; negative predictive value, 100%; sensitivity, 100%; specificity, 89.0%; and accuracy, 90.0%. There was excellent interobserver agreement in the assessment of graft attenuation (intraclass correlation coefficient, 0.957; κ = 1.00). Conclusion Low graft attenuation can be associated with 1-month mortality or graft failure in liver graft recipients with primary IPF. © RSNA, 2017.

PMID: 29267144 [PubMed - as supplied by publisher]



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Decreasing use of radioactive iodine for low risk thyroid cancer in California, 1999-2015.

Decreasing use of radioactive iodine for low risk thyroid cancer in California, 1999-2015.

J Clin Endocrinol Metab. 2017 Dec 15;:

Authors: Park KW, Wu JX, Du L, Leung AM, Yeh MW, Livhits MJ

Abstract
Context: Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines.
Objective: To assess recent stage-specific trends in utilization of RAI ablation.
Design, Setting and Patients: Retrospective study of patients with DTC (1999-2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, p-values, and multivariable analyses using RAI as the predictor variable.
Main Outcome Measures: Trends and drivers of RAI ablation for low-risk DTC.
Results: Of 46,906 patients with DTC who underwent near-total or total thyroidectomy (mean age 48.2±15.5 [SD] years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Utilization of RAI for patients with localized disease (no extrathyroidal extension, lymph node or distant metastases) decreased from 55% (1999) to 30% (2015), with the most significant change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1-2 cm (62% to 34%) and 2-4 cm (67% to 49%), and remained stable at 59% for tumors >4 cm. In multivariable analysis, patients with localized disease were less likely to receive RAI if they were >65 years old (OR 0.77, 95% CI: 0.71-0.83), had tumors <1 cm (OR 0.33, 95% CI: 0.31-0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67-0.75).
Conclusions: The rate of RAI ablation has decreased over time, mainly attributable to decreased use for localized DTCs < 2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.

PMID: 29267880 [PubMed - as supplied by publisher]



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Concurrent Intrathyroidal Thyroid Cancer and Thyroid Cancer in Struma Ovarii: A Case Report and Literature Review.

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Concurrent Intrathyroidal Thyroid Cancer and Thyroid Cancer in Struma Ovarii: A Case Report and Literature Review.

J Endocr Soc. 2017 May 01;1(5):396-400

Authors: Middelbeek RJW, O'Neill BT, Nishino M, Pallotta JA

Abstract
Context: The presence of differentiated thyroid cancer in mature cystic teratomas in the ovaries is rare, and usually incidentally found on surgical pathology specimens. We present a case of simultaneous intrathyroidal thyroid cancer and thyroid cancer within a struma ovarii, presenting specific diagnostic challenges.
Case Description: A 55-year-old woman had an intrathyroidal, encapsulated 1.2-cm papillary thyroid carcinoma, follicular variant, which was resected. Laboratory studies showed an elevated thyroglobulin level of 35 ng/mL while on suppressive levothyroxine therapy. During preparation for radioactive iodine ablation, thyroglobulin increased dramatically to 3490 ng/mL. A pretreatment whole-body scan showed residual tracer uptake in the thyroid bed and increased radiotracer uptake in the pelvis that raised concern for a pelvic metastasis, given the marked thyroglobulin elevation. After ablation, the posttreatment scan showed intense focal uptake in the pelvis. Single-photon emission computed tomography-computed tomography confirmed that the tracer uptake corresponded to a right adnexal mass. The patient underwent a laparoscopic bilateral salpingo-oophorecotomy with pelvic washings. The final pathology of the right ovary showed papillary thyroid carcinoma arising in a mature cystic teratoma. In addition, there was abundant normal thyroid tissue with colloid surrounding the carcinoma, indicating a source for the dramatic rise in thyroglobulin levels and suggesting that the ovarian papillary thyroid cancer arose within the teratoma and was not metastatic disease. Thyroglobulin measurements have been undetectable for 5 years since surgery and radioiodine treatment.
Conclusions: Concurrent intrathyroidal thyroid cancer and differentiated thyroid cancer in struma ovarii are very rare, but can often be distinguished on clinical grounds.

PMID: 29264493 [PubMed]



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Restoring Radioiodine Uptake in BRAF V600E-Mutated Papillary Thyroid Cancer.

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Restoring Radioiodine Uptake in BRAF V600E-Mutated Papillary Thyroid Cancer.

J Endocr Soc. 2017 Apr 01;1(4):285-287

Authors: Huillard O, Tenenbaum F, Clerc J, Goldwasser F, Groussin L

Abstract
This image illustrates a multimodal therapeutic strategy for an iodine-refractory BRAF-mutated metastatic papillary thyroid carcinoma with reversed radioiodine resistance using BRAF inhibitors.

PMID: 29264486 [PubMed]



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Rescue of Graves Thyrotoxicosis-Induced Cholestatic Liver Disease Without Antithyroid Drugs: A Case Report.

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Rescue of Graves Thyrotoxicosis-Induced Cholestatic Liver Disease Without Antithyroid Drugs: A Case Report.

J Endocr Soc. 2017 Mar 01;1(3):231-236

Authors: Yan LD, Thomas D, Schwartz M, Reich J, Steenkamp D

Abstract
Graves thyrotoxicosis rarely presents with painless jaundice resulting from hyperthyroidism-associated hepatotoxicity, without preexisting liver disease. Management in patients with this presentation is challenging, given that the thionamides, methimazole and propylthiouracil, have both been associated with drug-induced liver injury. Radioactive iodine ablation and thyroidectomy are well-established alternatives, but each have their associated risks and contraindications. We present an unusual case of severe hyperthyroidism-associated hepatotoxicity, in which adjuvant therapies, including glucocorticoids, saturated solution of potassium iodide, and cholestyramine, were used as a bridge to definitive therapy with thyroidectomy.

PMID: 29264480 [PubMed]



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An Unusual Case of Metastatic Functional Thyroid Carcinoma With a Remarkable Treatment Response to Radioactive Iodine.

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An Unusual Case of Metastatic Functional Thyroid Carcinoma With a Remarkable Treatment Response to Radioactive Iodine.

J Endocr Soc. 2017 Dec 01;1(12):1440-1444

Authors: Geliebter A, Brutsaert EF, Surks MI

Abstract
Functional thyroid carcinoma is an unusual cause of thyrotoxicosis. We describe the clinical presentation and treatment of a patient with thyrotoxicosis due to functional thyroid carcinoma and Graves disease, and discuss potential mechanisms causing the thyrotoxicosis. A 79-year-old woman with a remote history of hemithyroidectomy and current hyperthyroidism came to the hospital with upper and lower extremity weakness. Hospital evaluation revealed a suppressed thyroid-stimulating hormone (TSH) level, positive test for thyroid-stimulating immunoglobulins, as well as a thyroid nodule, lung masses, and a 4.4-cm gluteal mass. Fine-needle aspiration of the gluteal mass revealed metastatic differentiated thyroid carcinoma. Even after completion thyroidectomy and excision of her gluteal mass, her hyperthyroid status continued when she was not receiving levothyroxine. A radioactive iodine uptake and scan revealed unusually high lung uptake of 40%, and she was successfully treated with radioactive iodine (RAI) despite complete TSH suppression. The patient developed hypothyroidism 2 months after RAI administration; 6 months after RAI administration, her thyroglobulin (Tg) levels had fallen from a peak of 1976 ng/mL to 1.4 ng/mL. She had no anti-Tg antibodies. Repeated positron emission tomography-computed tomography nearly 1 year after RAI treatment shows substantial regression in the lung nodules, and Tg measured by mass spectroscopy is undetectable. This case demonstrates that thyrotoxicosis in the setting of metastatic thyroid carcinoma may be the result of functional thyroid carcinoma and may be successfully treated with selective surgery and RAI administration.

PMID: 29264468 [PubMed]



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Care-Related Quality of Life of Informal Caregivers After Geriatric Rehabilitation.

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Care-Related Quality of Life of Informal Caregivers After Geriatric Rehabilitation.

J Am Med Dir Assoc. 2017 Mar 01;18(3):259-264

Authors: van Dam PH, Achterberg WP, Caljouw MA

Abstract
OBJECTIVES: To describe care-related quality of life (CarerQoL) of informal caregivers after geriatric rehabilitation (GR) and identify associated determinants.
DESIGN: A cross-sectional analysis within a prospective longitudinal follow-up study.
SETTING: Evaluations at 4 weeks after finishing GR in 16 skilled nursing facilities.
PARTICIPANTS: Included were 350 informal caregivers (66.2% female, age 63 years; standard deviation [SD], 13.3) and their care recipients (63.4% female, age 78 years; interquartile range [IQR], 69-84 years).
MEASUREMENTS: CarerQoL was measured with the CarerQoL-7D. This instrument describes caregiver burden in seven dimensions (ie, fulfillment, relational, mental, social, financial, perceived support, and physical). Informal caregivers were divided into low and high CarerQoL groups, based on the median CarerQoL-7D summary score (83.9 [IQR, 74.4-91.7]). Potential associated determinants were collected, including demographic variables of informal caregivers and care recipients, self-rated health and burden of informal caregivers, functioning, and cognition and depression of care recipients. Univariate logistic regression was performed for each determinant. For the multivariate regression model, a backward procedure was used, which included age, gender, and variables with P < .10.
RESULTS: Multivariate analysis showed that fair or poor health (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.14-1.54), a higher self-rated burden (OR, 2.68 [95% CI, 1.23-5.85]), being happier if one could hand over all care tasks to another self-chosen person (OR, 1.33 [95% CI, 1.15-1.53]), and severely impaired cognitive performance level of the care recipient (OR, 2.52 [95% CI, 1.21-5.25]) were independently associated with having a lower CarerQoL-7D summary score (beneath the median). Happiness (OR, 0.53 [95% CI, 0.40-0.70]) was independently associated with a higher CarerQoL-7D summary score.
CONCLUSION: CarerQoL after GR in a skilled nursing facility is predominantly and independently associated with caregiver's own health, happiness, self-rated burden, and a severely impaired cognitive performance level of the care recipient at admission to the GR unit.

PMID: 27838337 [PubMed - indexed for MEDLINE]



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Development of the EORTC QLQ-CAX24, A Questionnaire for Cancer Patients With Cachexia.

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Development of the EORTC QLQ-CAX24, A Questionnaire for Cancer Patients With Cachexia.

J Pain Symptom Manage. 2017 Feb;53(2):232-242

Authors: Wheelwright SJ, Hopkinson JB, Darlington AS, Fitzsimmons DF, Fayers P, Balstad TR, Bredart A, Hammerlid E, Kaasa S, Nicolatou-Galitis O, Pinto M, Schmidt H, Solheim TS, Strasser F, Tomaszewska IM, Johnson CD, EORTC Quality of Life Group

Abstract
CONTEXT: Cachexia is commonly found in cancer patients and has profound consequences; yet there is only one questionnaire that examines the patient's perspective.
OBJECTIVE: To report a rigorously developed module for patient self-reported impact of cancer cachexia.
METHODS: Module development followed published guidelines. Patients from across the cancer cachexia trajectory were included. In Phase 1, health-related quality of life (HRQOL) issues were generated from a literature review and interviews with patients in four countries. The issues were revised based on patient and health care professional (HCP) input. In Phase 2, questionnaire items were formulated and translated into the languages required for Phase 3, the pilot phase, in which patients from eight countries scored the relevance and importance of each item, and provided qualitative feedback.
RESULTS: A total of 39 patients and 12 HCPs took part in Phase 1. The literature review produced 68 HRQOL issues, with 22 new issues arising from the patient interviews. After patient and HCP input, 44 issues were formulated into questionnaire items in Phase 2. One hundred ten patients took part in Phase 3. One item was reworded, and 20 items were deleted as a consequence of patient feedback.
CONCLUSIONS: The QLQ-CAX24 is a cancer cachexia-specific questionnaire, comprising 24 items, for HRQOL assessment in clinical trials and practice. It contains five multi-item scales (food aversion, eating and weight-loss worry, eating difficulties, loss of control, and physical decline) and four single items.

PMID: 27810567 [PubMed - indexed for MEDLINE]



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Frequency and Predictors of Acute Hospitalization Before Death in Patients With Glioblastoma.

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Frequency and Predictors of Acute Hospitalization Before Death in Patients With Glioblastoma.

J Pain Symptom Manage. 2017 Feb;53(2):257-264

Authors: Diamond EL, Panageas KS, Dallara A, Pollock A, Applebaum AJ, Carver AC, Pentsova E, DeAngelis LM, Prigerson HG

Abstract
CONTEXT: Glioblastoma (GBM) is a devastating and incurable neuro-oncologic disease, and issues related to the end of life are almost invariably a matter of "when," not a matter of "if." Optimizing symptom management and quality of life in later stages of disease is of the utmost priority.
OBJECTIVES: To examine the frequency of and factors associated with late acute hospital admission before death in patients with GBM.
METHODS: Case-control study comparing patients with GBM admitted to the hospital within one month of death to those without late hospital admission.
RESULTS: Of 385 GBM patients followed to death at Memorial Sloan Kettering Cancer Center, 164 (42.6%) were admitted within a month of death, most frequently (140, or 85%) to manage neurologic decline. Of these, 56 (34%) had intensive care unit care during this admission and 22 (13%), 18 (11%), and 2 (1%) received mechanical ventilation, enteral feeding tubes, or cardiopulmonary resuscitation, respectively. In multivariable analysis, in-hospital chaplaincy consultation, and participation in a therapeutic clinical trial, both at any time in the GBM disease course, were significantly associated with late hospital admission.
CONCLUSIONS: Late hospitalization is frequent in GBM and often involves intensive care unit care in the management of clinical events that are part of the GBM dying process. Patients with a tendency to use religious support and those enrolled in clinical trials may be at greater risk for late hospitalization. Dedicated prospective study is needed to determine predictors of late hospitalization and to examine the impact of late acute medical care on quality of life in GBM.

PMID: 27810565 [PubMed - indexed for MEDLINE]



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Health Status Trajectories Among Outpatients With Heart Failure.

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Health Status Trajectories Among Outpatients With Heart Failure.

J Pain Symptom Manage. 2017 Feb;53(2):224-231

Authors: Flint KM, Schmiege SJ, Allen LA, Fendler TJ, Rumsfeld J, Bekelman D

Abstract
CONTEXT: Health status (i.e., symptoms, function, and quality of life) is an important palliative care outcome in patients with heart failure; however, patterns of health status over time (i.e., trajectories) are not well described.
OBJECTIVES: The objective of this study was to identify health status trajectories in outpatients with heart failure and assess whether depression, symptom burden, or sense of peace predict health status trajectory.
METHODS: This is an observational study utilizing data from the Patient-Centered Disease Management for Heart Failure trial. Participants completed Kansas City Cardiomyopathy Questionnaires at baseline, three, six, and 12 months. Latent class growth analysis identified health status trajectories; multinomial logistic regression models identified predictors of trajectory membership.
RESULTS: Patients (n = 384) were primarily men (97%) and older (mean age 67.6 ± 10.1). Three health status trajectories were identified. All three trajectories improved at three months; however, the marked improvement health status trajectory (n = 19) showed progressive improvement over one year, whereas the poor (n = 119) and moderate (n = 246) health status trajectories had little change after three months. In adjusted analyses, worse baseline depression (odds ratio 1.10; 95% confidence interval 1.01-1.20), symptom burden (1.45; 1.15-1.83), and sense of peace (0.41; 0.22-0.75) predicted membership in the poor vs. moderate health status trajectory.
CONCLUSION: We identified three one-year health status trajectories in patients with heart failure, with the two most common trajectories characterized by early improvement followed by limited change. Future research should assess these findings in nonveterans and women and explore whether treatment of depression, high symptom burden, and low sense of peace leads to improved long-term heart failure health status trajectory.

PMID: 27756621 [PubMed - indexed for MEDLINE]



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The non-motor side of the honeymoon period of Parkinson's disease and its relationship with quality of life: a 4-year longitudinal study.

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The non-motor side of the honeymoon period of Parkinson's disease and its relationship with quality of life: a 4-year longitudinal study.

Eur J Neurol. 2016 Nov;23(11):1673-1679

Authors: Erro R, Picillo M, Vitale C, Amboni M, Moccia M, Santangelo G, Pellecchia MT, Barone P

Abstract
BACKGROUND AND PURPOSE: Very little is known about the progression of non-motor symptoms (NMSs) in Parkinson's disease (PD) and there are no longitudinal studies exploring this topic from the earliest stage, when patients receive the diagnosis. We here report on the progression of NMSs over 4 years from diagnosis in a cohort of de-novo, previously untreated, patients with PD.
METHODS: Consecutive de-novo (disease duration < 2 years), untreated patients with PD were enrolled in this observational study. Evaluations were then scheduled every 2 years and included assessment of motor and non-motor features as well as of quality of life measures.
RESULTS: Sixty-one patients were prospectively followed-up for 4 years from diagnosis. The majority of NMSs increased over time and significantly affected quality of life, whereas motor disability did not. There was no significant association between NMSs and dopaminergic therapy in terms of both drug class and total levodopa-equivalent daily dosage. Excessive daytime sleepiness was the only NMS correlating with therapy with dopamine agonists. Female patients were more likely to have worse quality of life.
CONCLUSIONS: Non-motor symptoms significantly increase over time, with a different progression rate for each one. NMSs significantly affect quality of life in PD and we here demonstrated that this was especially the case when patients were in their (motor) honeymoon period. Future trials should target non-dopaminergic networks and consider NMSs in their outcomes.

PMID: 27435448 [PubMed - indexed for MEDLINE]



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Take-home message: improve naloxone supply

People may be dying from opiate overdose partly because of chronically inadequate provision of take-home naloxone in England, the drugs charity Release has concluded after reviewing the data.1 The...
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Pathogens, Vol. 7, Pages 1: Multifaceted Defense against Listeria monocytogenes in the Gastro-Intestinal Lumen

Pathogens, Vol. 7, Pages 1: Multifaceted Defense against Listeria monocytogenes in the Gastro-Intestinal Lumen

Pathogens doi: 10.3390/pathogens7010001

Authors: Simone Becattini Eric Pamer

Listeria monocytogenes is a foodborne pathogen that can cause febrile gastroenteritis in healthy subjects and systemic infections in immunocompromised individuals. Despite the high prevalence of L. monocytogenes in the environment and frequent contamination of uncooked meat and poultry products, infections with this pathogen are relatively uncommon, suggesting that protective defenses in the general population are effective. In the mammalian gastrointestinal tract, a variety of defense mechanisms prevent L. monocytogenes growth, epithelial penetration and systemic dissemination. Among these defenses, colonization resistance mediated by the gut microbiota is crucial in protection against a range of intestinal pathogens, including L. monocytogenes. Here we review defined mechanisms of defense against L. monocytogenes in the lumen of the gastro-intestinal tract, with particular emphasis on protection conferred by the autochthonous microbiota. We suggest that selected probiotic species derived from the microbiota may be developed for eventual clinical use to enhance resistance against L. monocytogenes infections.



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Feedback: Fairy lights shine in Britain as elf sightings rise

elf-800x533.jpg

But these grouchy imps don't come bearing gifts. Plus: Feedback's gift guide, from space socks to isolation vases, a special election in America, and more

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JDB, Vol. 6, Pages 1: Modeling Alzheimer’s and Other Age Related Human Diseases in Embryonic Systems

JDB, Vol. 6, Pages 1: Modeling Alzheimer’s and Other Age Related Human Diseases in Embryonic Systems

Journal of Developmental Biology doi: 10.3390/jdb6010001

Authors: Chu Lim Ajay Mathuru

Modeling human disease in animals is an important strategy to discover potential methods of intervention. We suggest that there is much to be gained by employing a multi-model approach that takes advantage of different animal systems used in the laboratory simultaneously. We use the example of modeling Alzheimer’s disease in Drosophila melanogaster, Caenorhabditis elegans, and Danio rerio to illustrate how such an approach can be employed to investigate the pathophysiology of the disease.



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Quantifier float as stranding

Abstract

Quantifier float (as in The kids are all reading) has received two main analyses, with no consensus emerging as to which is superior. Under the stranding analysis (Sportiche 1988, a.m.o.), a floated quantifier and its associate underlyingly form a single nominal phrase (e.g., all the kids), which is broken up in the course of the derivation by movement of the associate to a higher position. Under the adverbial analysis (Doetjes 1992, a.m.o.), a floated quantifier does not form a constituent with its associate at any stage of the derivation; rather, it is an adverbial element adjoined to some clausal projection. This paper presents novel data from P’urhepecha (isolate, central-western Mexico)—and specifically from the variety spoken on the island of Janitzio on Lake Pátzcuaro—that argue strongly in favor of the stranding analysis for this language. Janitzio P’urhepecha makes available a strikingly wide array of DP positions (most of them “subject” positions), and the distribution of floated quantifiers tracks that of ordinary DPs extremely faithfully. In addition, floated quantifiers match their associates in morphological case. These findings pose a considerable challenge to the hypothesis that quantifier float is universally derived by adjunction of the floated quantifier to a clausal projection.



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IJMS, Vol. 19, Pages 26: Effects of Glucagon-Like Peptide-1 on Oxidative Stress and Nrf2 Signaling

IJMS, Vol. 19, Pages 26: Effects of Glucagon-Like Peptide-1 on Oxidative Stress and Nrf2 Signaling

International Journal of Molecular Sciences doi: 10.3390/ijms19010026

Authors: Yoon Oh Hee-Sook Jun

Oxidative cellular damage caused by free radicals is known to contribute to the pathogenesis of various diseases such as cancer, diabetes, and neurodegenerative diseases, as well as to aging. The transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) and Kelch-like ECH-associated protein1 (Keap1) signaling pathways play an important role in preventing stresses including oxidative and inflammatory stresses. Nrf2 is a master regulator of cellular stress responses, induces the expression of antioxidant and detoxification enzymes, and protects against oxidative stress-induced cell damage. Glucagon-like peptide-1 (GLP-1) is an incretin hormone, which was originally found to increase insulin synthesis and secretion. It is now widely accepted that GLP-1 has multiple functions beyond glucose control in various tissues and organs including brain, kidney, and heart. GLP-1 and GLP-1 receptor agonists are known to be effective in many chronic diseases, including diabetes, via antioxidative mechanisms. In this review, we summarize the current knowledge regarding the role of GLP-1 in the protection against oxidative damage and the activation of the Nrf2 signaling pathway.



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Antibacterial mechanisms of a novel type picosecond laser-generated silver-titanium nanoparticles and their toxicity to human cells

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The Christmas gift of genetic uncertainty

John is a 32 year old father of two who had been troubled by excess earwax since childhood. Turning to “Dr Google” he thought that his type of earwax might be the result of a genetic change (single...
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Phylogeography of the Ibero-Maghrebian red-eyed grass snake ( Natrix astreptophora )

Abstract

We examined phylogeographic differentiation of the red-eyed grass snake (Natrix astreptophora) using 1984 bp of mtDNA and 13 microsatellite loci from specimens collected across its distribution range in southwestern Europe and northwestern Africa. Based on phylogenetic analyses of mtDNA, European N. astreptophora constituted the sister clade to a weakly supported North African clade comprised of two deeply divergent and well-supported clades, one corresponding to Moroccan snakes and the other to snakes from Algeria and Tunisia. This tripartite differentiation was confirmed by analyses of microsatellite loci. According to a fossil-calibrated molecular clock, European and North African N. astreptophora diverged 5.44 million years ago (mya), and the two Maghrebian clades split 4.64 mya. These dates suggest that the radiation of the three clades was initiated by the environmental changes related to the Messinian Salinity Crisis and the reflooding of the Mediterranean Basin. The differentiation of N. astreptophora, with distinct clades in the Iberian Peninsula and in the western and eastern Maghreb, corresponds to a general phylogeographic paradigm and resembles the differentiation found in another co-distributed Natrix species, the viperine snake (N. maura). Despite both species being good swimmers, the Strait of Gibraltar constitutes a significant biogeographic barrier for them. The discovery that North Africa harbours two endemic lineages of N. astreptophora necessitates more conservation efforts for these imperilled snakes.



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Issue Information



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Issue Information



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Use of hormone replacement therapy improves the prognosis in patients with colorectal cancer: A population-based study in Sweden

Abstract

The association between hormone therapy (estrogen, with or without progesterone) and colorectal cancer (CRC) has received considerable scientific interest but previous research has generated inconsistent results. We aimed to examine whether post-diagnostic use of hormone therapy might protect against CRC mortality and all-cause mortality. Women diagnosed with CRC between January 2007 and December 2012 were identified from the Swedish Cancer Registry and linked to the Swedish Prescribed Drug Register to retrieve hormone therapy users after CRC diagnosis. A total of 1109 patients were diagnosed with CRC and used hormone therapy post-CRC diagnosis. Time-dependent Cox regression with 1-year lag was used to calculate the hazard ratio (HR) of CRC mortality and all-cause mortality associated with post-diagnostic use of hormone therapy. Use of hormone therapy after CRC diagnosis was associated with a 26% risk reduction in CRC mortality (HR=0.67, 95%CI 0.56-0.79) and a 30% risk reduction in all-cause mortality (HR=0.68, 95%CI 0.59-0.77). The risk reduction was even stronger if women also used hormone therapy before the diagnosis of CRC and for women with higher cumulative doses of hormone therapy. The risk reduction was largely consistent irrespective of CRC severity. Our data suggests that use of hormone therapy after CRC diagnosis is associated with a decreased risk of cancer-related mortality and all-cause mortality. This article is protected by copyright. All rights reserved.



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The association of weight change in young adulthood and smoking status with risk of prostate cancer recurrence

Abstract

The decades before prostate cancer diagnosis represent an etiologically relevant time period for prostate cancer carcinogenesis. However, the association of weight gain in young adulthood with subsequent biochemical recurrence among men with prostate cancer is not well studied, particularly among smokers. We conducted a prospective cohort study of 1082 men with prostate cancer and treated with either radical prostatectomy or radiation between 2003-2010. The association of weight at age 20, weight at age 50, and weight change from age 20 to 50 with biochemical recurrence was assessed using Cox Proportional Hazards with adjustment for confounders. Stratum specific hazard ratio (HR) estimates by smoking status were evaluated. In the overall cohort, weight at age 20 (HR per 30 kg: 1.56, 95% Confidence Interval (CI): 1.02, 2.38, p-trend: 0.039), weight at age 50 (HR per 30 kg: 1.80, 95% CI: 1.32, 2.47, p-trend: <0.001), and weight change from age 20 to 50 (HR per 30 kg: 1.84, 95% CI: 1.24, 2.74, p-trend: 0.003) were associated with biochemical recurrence. In stratified analyses, weight change from age 20 to 50 was significantly associated with biochemical recurrence only in former smokers (HR per 30 kg: 3.87, 95% CI: 1.88, 8.00, p-trend: <0.001) and ever smokers (HR per 30 kg: 2.38, 95% CI: 1.27, 4.45, p-trend: 0.007). No significant association was observed between weight gain in young adulthood and biochemical recurrence in never smokers. This study adds further evidence that weight gain during early adult years conveys long-term risk for adverse cancer outcomes. This article is protected by copyright. All rights reserved.



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Smoking, alcohol, and diet in relation to risk of pancreatic cancer in China: a prospective study of 0.5 million people

Abstract

In China, the incidence of pancreatic cancer (PC) has increased in recent decades. However, little is known about the relevance to PC risk of lifestyle and behavioral factors such as smoking, alcohol drinking, and diet. The China Kadoorie Biobank prospective study recruited 512,891 adults (210,222 men, 302,669 women) aged 30–79 (mean 52) years from 10 diverse areas during 2004–08. During ~9 years of follow-up, 688 incident cases of PC were recorded among those who had no prior history of cancer at baseline. Cox regression yielded adjusted hazard ratios (HR) for PC associated with smoking, alcohol and selected dietary factors. Overall, 74% of men were ever-regular smokers and 33% of men drank at least weekly, compared with only 3% and 2% of women, respectively. Among men, current regular smoking was associated with an adjusted HR of 1.25 (95% CI 1.08–1.44) for PC, with greater excess risk in urban than rural areas (1.46 [1.19–1.79] vs 1.04 [0.86–1.26]). Heavy, but not light to moderate, alcohol drinking (i.e. ≥420 g/week) was associated with significant excess risk (1.69 [1.21–2.37]), again more extreme in urban than rural areas (1.93 [1.29–2.87] vs 1.35 [0.74–2.48]). Overall, regular consumption of certain foodstuffs was associated with PC risk, with adjusted daily vs never/rare consumption HRs of 0.66 (0.56–0.79) for fresh fruit and 1.16 (1.01–1.33) for red meat. In China, smoking and heavy alcohol drinking were independent risk factors for PC in men. Lower fresh fruit and higher red meat consumption were also associated with higher risk of PC.ibitor treatment may be most effective on colorectal tumors expressing highest levels of calpain-2.

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This is the first prospective study in China investigating the association of smoking, alcohol, and diet with risk of pancreatic cancer. Among male participants, we found that smoking and heavy alcohol drinking were associated with higher risk of pancreatic cancer. In both men and women, high fresh fruit consumption and low meat consumption were associated with lower risk of pancreatic cancer.



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Trends and clinicopathological predictors of axillary evaluation in ductal carcinoma in situ patients treated with breast-conserving therapy

Abstract

The aim of this study was to investigate the trends of axillary lymph node evaluation in ductal carcinoma in situ (DCIS) patients treated with breast-conserving therapy (BCT) and to identify the clinicopathological predictors of axillary evaluation. DCIS patients treated with BCT in 2006–2015 at our institute were retrospectively included in the analysis. Patients were categorized into three groups: sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), and non-evaluation. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted axillary evaluation. A total of 315 patients were identified, among whom 135 underwent SLNB, and 15 underwent ALND. The proportion of patients who underwent axillary evaluation increased from 33.0% in 2006–2010 to 53.8% in 2011–2015 (< 0.001), however, no patients had lymph node metastasis based on final pathology. In multivariate analysis, high-grade tumor favored axillary evaluation (OR = 4.376, 95% CI:1.410–13.586, = 0.011); while excision biopsy favored no axillary evaluation compared with other biopsy methods (OR = 0.418, 95% CI: 0.192–0.909, = 0.028). Subgroup analysis of patients treated in 2011–2015 revealed that high-grade tumor (OR = 5.898, 95% CI: 1.626–21.390, = 0.007) and palpable breast lump (OR = 2.497, 95% CI: 1.037–6.011, = 0.041) were independent predictors of axillary lymph node evaluation. Despite the significant decrease in ALND and a concerning overuse of SLNB, we identified no axillary lymph node metastasis, which justified omitting axillary evaluation in these patients. High-grade tumor, palpable lump, and biopsy method were independent predictors of axillary evaluations. Excision biopsy of suspicious DCIS lesions may potentially preclude the invasive component of the disease and help to avoid axillary surgery

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We identified no axillary lymph node metastasis in ductal carcinoma in situ patients who received breast-conserving surgery, which justified omitting axillary evaluation in these patients. High-grade tumor, palpable lump, and biopsy method were independent predictors of axillary evaluations. Excision biopsy of suspicious DCIS lesions may potentially preclude the invasive component of the disease and help to avoid axillary surgery.



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Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer: results of “Cancer POP” study

Abstract

The aim of this study was to investigate the incidence and risk factors of postoperative pneumonia (POP) within 1 year after cancer surgery in patients with the five most common cancers (gastric, colorectal, lung, breast cancer, and hepatocellular carcinoma [HCC]) in South Korea. This was a multicenter and retrospective cohort study performed at five nationwide cancer centers. The number of cancer patients in each center was allocated by the proportion of cancer surgery. Adult patients were randomly selected according to the allocated number, among those who underwent cancer surgery from January to December 2014 within 6 months after diagnosis of cancer. One-year cumulative incidence of POP was estimated using Kaplan–Meier analysis. An univariable Cox's proportional hazard regression analysis was performed to identify risk factors for POP development. As a multivariable analysis, confounders were adjusted using multiple Cox's PH regression model. Among the total 2000 patients, the numbers of patients with gastric cancer, colorectal cancer, lung cancer, breast cancer, and HCC were 497 (25%), 525 (26%), 277 (14%), 552 (28%), and 149 (7%), respectively. Overall, the 1-year cumulative incidence of POP was 2.0% (95% CI, 1.4–2.6). The 1-year cumulative incidences in each cancer were as follows: lung 8.0%, gastric 1.8%, colorectal 1.0%, HCC 0.7%, and breast 0.4%. In multivariable analysis, older age, higher Charlson comorbidity index (CCI) score, ulcer disease, history of pneumonia, and smoking were related with POP development. In conclusions, the 1-year cumulative incidence of POP in the five most common cancers was 2%. Older age, higher CCI scores, smoker, ulcer disease, and previous pneumonia history increased the risk of POP development in cancer patients.

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The 1-year cumulative incidence of postoperative pneumonia in the five most common cancers (gastric, colorectal, lung, breast cancer, and hepatocellular carcinoma) was 2% in South Korea. Older age, higher Charlson comorbidity index scores, smoker, ulcer disease, and previous pneumonia history increased the risk of postoperative pneumonia development in cancer patients.



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Optimizing the identification of risk-relevant mutations by multigene panel testing in selected hereditary breast/ovarian cancer families

Abstract

The introduction of multigene panel testing for hereditary breast/ovarian cancer screening has greatly improved efficiency, speed, and costs. However, its clinical utility is still debated, mostly due to the lack of conclusive evidences on the impact of newly discovered genetic variants on cancer risk and lack of evidence-based guidelines for the clinical management of their carriers. In this pilot study, we aimed to test whether a systematic and multiparametric characterization of newly discovered mutations could enhance the clinical utility of multigene panel sequencing. Out of a pool of 367 breast/ovarian cancer families Sanger-sequenced for BRCA1 and BRCA2 gene mutations, we selected a cohort of 20 BRCA1/2-negative families to be subjected to the BROCA-Cancer Risk Panel massive parallel sequencing. As a strategy for the systematic characterization of newly discovered genetic variants, we collected blood and cancer tissue samples and established lymphoblastoid cell lines from all available individuals in these families, to perform segregation analysis, loss-of-heterozygosity and further molecular studies. We identified loss-of-function mutations in 6 out 20 high-risk families, 5 of which occurred on BRCA1, CHEK2 and ATM and are esteemed to be risk-relevant. In contrast, a novel RAD50 truncating mutation is most likely unrelated to breast cancer. Our data suggest that integrating multigene panel testing with a pre-organized, multiparametric characterization of newly discovered genetic variants improves the identification of risk-relevant alleles impacting on the clinical management of their carriers.

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Multigene panel sequencing for the diagnosis of hereditary breast/ovarian cancer syndromes is raising concerns due to the absence of univocal interpretation of the cancer risk conferred by non-BRCA1/2 mutations. Integrating these technologies with a systematic and multiparametric characterization of newly discovered genetic variants improves the identification of risk-relevant alleles enhancing their clinical utility.



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Vitamin D deficiency and supplementation in patients with aggressive B-cell lymphomas treated with immunochemotherapy

Abstract

Vitamin D deficiency has been reported to be a negative prognostic factor in elderly patients with aggressive B-cell lymphomas. In vitro data suggest that vitamin D supplementation may enhance rituximab-mediated cytotoxicity. We prospectively assessed 25-hydroxyvitamin D [25(OH)D] levels at diagnosis in a cohort of 155 patients with aggressive B-cell lymphomas of whom 128 had diffuse large B-cell lymphoma (DLBCL) not otherwise specified. 25(OH)D levels were deficient (<20 ng/mL) in 105 (67%), insufficient (20–29 ng/mL) in 32 (21%), and normal (≥30 ng/mL) in 18 (12%) patients with a seasonal variation. Patient characteristics associated with lower 25(OH)D levels were poor performance status, overweight, B-symptoms, elevated LDH, lower albumin and hemoglobin levels. As a result of a change in practice pattern, 116 patients received vitamin D3 (cholecalciferol) supplementation that included a loading phase with daily replacement and subsequent maintenance phase with a weekly dose of 25,000 IU until end of treatment. This resulted in a significant increase in 25(OH)D levels, with normalization in 56% of patients. We analyzed the impact of 25(OH)D levels on event-free survival in patients treated with Rituximab-CHOP. 25(OH)D levels below 20 ng/mL at diagnosis and IPI were independently associated with inferior EFS. Moreover, patients with normalized 25(OH)D levels following supplementation showed better EFS than patients with persistently deficient/insufficient 25(OH)D levels. Our study provides the first evidence that achievement of normal 25(OH)D levels after vitamin D3 supplementation is associated with improved outcome in patients with DLBCL and deficient/insufficient 25(OH)D levels when receiving rituximab-based treatment.

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Low 25-hydroxyvitamin D (25(OH)D) levels are frequent in patients with aggressive B-cell lymphomas and are associated with host- and disease-related patient characteristics and outcome. Supplementation with Vitamin D3 can rapidly increase 25(OH)D levels and may improve outcome.



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Odd fossils hint first complex life hung on long after its time

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The strange Ediacarans were some of the earliest complex organisms on Earth. They are thought to have died out 540 million years ago but eight odd fossils suggest they survived far longer

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Systematic Review of Combined Pharmacotherapy for the Treatment of Alcohol Use Disorder in Patients Without Comorbid Conditions

Abstract

Background

Previous reviews have examined the use of theoretically supported combinations of drugs for the treatment of alcohol use disorder. This review seeks to examine the strengths and limitations of current clinical evidence for the use of combined pharmacological interventions intended to treat alcohol use disorder.

Objectives

The objective of this review was to identify combinations of pharmacological treatments for alcohol use disorder, and assess the strength of clinical evidence for these treatments.

Methods

We conducted searches using PubMed, EMBASE® through Ovid® (1974 to present), MEDLINE® through Ovid® (1946 to present), and Psychinfo® through Ovid® (1806 to present). Our primary search included the terms “alcoholism” and “drug therapy, combination”. Search results were restricted to human subjects and English language. Search criteria were not restricted based on study design or patient age. Studies were evaluated for randomization, blinding, group similarity, power determination, outcome reporting, and number of patients analyzed.

Results

Nine hundred and eighty-four publications were initially screened for inclusion after duplicates were removed. The search identified 16 publications evaluating drug combinations for the treatment of alcohol use disorder. The majority of published trials included naltrexone combined with one of the following: gabapentin, ondansetron, acamprosate, gamma-hydroxybutyrate, sertraline, quetiapine, or escitalopram plus gamma-hydroxybutyrate. Other combinations included 5-hydroxytryptophan with carbidopa/levodopa, gamma-hydroxybutyrate with disulfiram, acamprosate with disulfiram, and mirtazapine with quetiapine. Interpretation of results across studies was limited by low statistical power, and heterogeneity of drug combinations and outcome measures. Drug combination effect sizes were comparable to those observed in single-agent trials.

Conclusions

No significant benefit for the use of combinations over single agents was observed. However, benefit may be observed when combined pharmacological interventions address specific symptoms of alcohol use disorder known to be influenced by combination components, or when combinations are used in specific subpopulations in which combination components demonstrate benefit.



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IJMS, Vol. 19, Pages 28: Docosahexaenoic Acid in Combination with Dietary Energy Restriction for Reducing the Risk of Obesity Related Breast Cancer

IJMS, Vol. 19, Pages 28: Docosahexaenoic Acid in Combination with Dietary Energy Restriction for Reducing the Risk of Obesity Related Breast Cancer

International Journal of Molecular Sciences doi: 10.3390/ijms19010028

Authors: Andrea Manni Karam El-Bayoumy Henry Thompson

There is strong evidence that obesity poses a significant risk factor for postmenopausal breast cancer. There are multiple mechanisms by which obesity can predispose to breast cancer, prominent among which is the creation of a pro-inflammatory milieu systemically in the visceral and subcutaneous tissue, as well as locally in the breast. Although dietary intervention studies have shown in general a favorable effect on biomarkers of breast cancer risk, it is still unclear whether losing excess weight will lower the risk. In this manuscript, we will review the evidence that omega-3 fatty acids, and among them docosahexaenoic acid (DHA) in particular, may reduce the risk of obesity related breast cancer primarily because of their pleotropic effects which target many of the systemic and local oncogenic pathways activated by excess weight. We will also review the evidence indicating that intentional weight loss (IWL) induced by dietary energy restriction (DER) will augment the tumor protective effect of DHA because of its complementary mechanisms of action and its ability to reverse the obesity-induced alterations in fatty acid metabolism predisposing to carcinogenesis. We believe that the combination of DER and DHA is a promising safe and effective intervention for reducing obesity-related breast cancer risk which needs to be validated in appropriately designed prospective, randomized clinical trials.



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Genes, Vol. 9, Pages 3: Transitioning from Forensic Genetics to Forensic Genomics

Genes, Vol. 9, Pages 3: Transitioning from Forensic Genetics to Forensic Genomics

Genes doi: 10.3390/genes9010003

Authors: Manfred Kayser Walther Parson

Due to its support of law enforcement, forensics is a conservative field; nevertheless, driven by scientific and technological progress, forensic genetics is slowly transitioning into forensic genomics. With this Special Issue of Genes we acknowledge and appreciate this rather recent development by not only introducing the field of forensics to the wider community of geneticists, but we do so by emphasizing on different topics of forensic relevance where genomic, transcriptomic, and epigenomic principles, methods, and datasets of humans and beyond are beginning to be used to answer forensic questions.



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IJERPH, Vol. 15, Pages 8: Adsorption Property and Mechanism of Oxytetracycline onto Willow Residues

IJERPH, Vol. 15, Pages 8: Adsorption Property and Mechanism of Oxytetracycline onto Willow Residues

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010008

Authors: Di Wang Haiyang Xu Shengke Yang Wenke Wang Yanhua Wang

To elucidate the adsorption property and the mechanism of plant residues to reduce oxytetracycline (OTC), the adsorption of OTC onto raw willow roots (WR-R), stems (WS-R), leaves (WL-R), and adsorption onto desugared willow roots (WR-D), stems (WS-D), and leaves (WL-D) were investigated. The structural characterization was analyzed by scanning electron microscopy, Fourier-transform infrared spectra, and an elemental analyzer. OTC adsorption onto the different tissues of willow residues was compared and correlated with their structures. The adsorption kinetics of OTC onto willow residues was found to follow the pseudo-first-order model. The isothermal adsorption process of OTC onto the different tissues of willow residues followed the Langmuir and Freundlich model and the process was also a spontaneous endothermic reaction, which was mainly physical adsorption. After the willow residues were desugared, the polarity decreased and the aromaticity increased, which explained why the adsorption amounts of the desugared willow residues were higher than those of the unmodified residues. These observations suggest that the raw and modified willow residues have great potential as adsorbents to remove organic pollutants.



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IJERPH, Vol. 15, Pages 9: Efficacy of Natural Polymer Derivatives on Soil Physical Properties and Erosion on an Experimental Loess Hillslope

IJERPH, Vol. 15, Pages 9: Efficacy of Natural Polymer Derivatives on Soil Physical Properties and Erosion on an Experimental Loess Hillslope

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010009

Authors: Jun’e Liu Zhanli Wang Yuanyuan Li

Raindrops disperse large soil aggregates into smaller particles, which can clog soil pores, cause soil crusting, reduce rainfall infiltration and increase soil loss. It was found that natural polymer derivatives were effective in improving soil physical properties and decreasing soil erosion on an experimental loess hillslope. This study investigated the effect of new natural polymer derivatives (Jag S and Jag C162) on soil properties, rainfall infiltration and sediment yield at four rates of sprayed polymers (0, 1, 3 and 5 g/m2), three rainfall intensities (1, 1.5 and 2 mm/min) and a slope gradient of 15° with a silt loam soil through simulated rain. The results showed that both Jag S and Jag C162 significantly increased the shear strength and improved the aggregates composition of the soil surface. The water-stable soil aggregates &gt;0.25 mm increased from 9% to 50% with increasing rates of Jag S and Jag C162. Jag S and Jag C162 also effectively increased rainfall infiltration and final infiltration rate, and reduced erosion compared to controls without natural polymer derivatives added. However, higher rates of Jag S produced lower infiltration rates. Although both Jag S and Jag C162 effectively influenced soil physical properties and erosion, the effect of Jag C162 was more significant than that of Jag S.



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IJERPH, Vol. 15, Pages 7: Personal, Psychosocial and Environmental Factors Related to Sick Building Syndrome in Official Employees of Taiwan

IJERPH, Vol. 15, Pages 7: Personal, Psychosocial and Environmental Factors Related to Sick Building Syndrome in Official Employees of Taiwan

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010007

Authors: Chung-Yen Lu Meng-Chuan Tsai Chih-Hsin Muo Yu-Hsien Kuo Fung-Chang Sung Chin-Ching Wu

Sick building syndrome (SBS) is a combination of symptoms that can be attributed to exposure to specific building conditions. The present study recruited 389 participants aged 20–65 years from 87 offices of 16 institutions to examine if personal factors, work-related psychosocial stress, and work environments, were associated with five groups of SBS symptoms, including symptoms for eyes, upper respiratory tract, lower respiratory tract, skin, and non-specific systems. Indoor environmental conditions were monitored. Data were analyzed using multivariate logistic regression (MLR) analyses and were reported as adjusted Odds Ratios (aOR). SBS symptoms for eyes were associated with older age, sensitivity to tobacco, and low indoor air flow. Upper respiratory symptoms were related to smoking, low social support, longer work days, and dry air. High indoor air flow was associated with reduced upper respiratory symptoms (aOR = 0.29; 95% confidence interval (CI) = 0.13–0.67). Lower respiratory symptoms were associated with high work pressure, longer work hours, chemical exposure, migraine, and exposure to new interior painting. Recent interior painting exposure was associated with a high estimated relative risk of low respiratory symptoms (aOR = 20.6; 95% CI = 2.96–143). Smoking, longer work days, low indoor air flow, indoor dryness, and volatile organics exposure, were associated with other non-specified symptoms including headache, tiredness, difficulty concentrating, anger, and dizziness. In conclusion, there are various SBS symptoms associated with different personal characteristics, psychosocial, and environmental factors. Psychosocial factors had stronger relationships with lower respiratory symptoms than with other types of SBS symptoms. Good ventilation could reduce risk factors and may relieve SBS symptoms.



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IJERPH, Vol. 15, Pages 6: Demand for Long-Term Care Insurance in China

IJERPH, Vol. 15, Pages 6: Demand for Long-Term Care Insurance in China

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010006

Authors: Qun Wang Yi Zhou Xinrui Ding Xiaohua Ying

The aim of this study was to estimate willingness to pay (WTP) for long-term care insurance (LTCI) and to explore the determinants of demand for LTCI in China. We collected data from a household survey conducted in Qinghai and Zhejiang on a sample of 1842 households. We relied on contingent valuation methods to elicit the demand for LTCI and random effects logistic regression to analyze the factors associated with the demand for LTCI. Complementarily, we used document analysis to compare the LTCI designed in this study and the current LTCI policies in the pilot cities. More than 90% of the respondents expressed their willingness to buy LTCI. The median WTP for LTCI was estimated at 370.14 RMB/year, accounting for 2.29% of average annual per capita disposable income. Price, age, education status, and income were significantly associated with demand for LTCI. Most pilot cities were found to mainly rely on Urban Employees Basic Medical Insurance funds as the financing source for LTCI. Considering that financing is one of the greatest challenges in the development of China’s LTCI, we suggest that policy makers consider individual contribution as an important and possible option as a source of financing for LTCI.



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A New Way to "See" Cancer

Combining near-infrared light with ultrasound could let doctors image tumors with unprecedented accuracy

-- Read more on ScientificAmerican.com
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3D DTI-MRI can suggest weak cervix, pregnancy issues

2017_12_21_19_17_0733_2017_12_22_MRI_cerThree-dimensional diffusion-tensor MRI (DTI-MRI) examinations of the cervix...


Read more on AuntMinnieEurope.com


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Water and sediment quality assessment in the Colastiné-Corralito stream system (Santa Fe, Argentina): impact of industry and agriculture on aquatic ecosystems

Abstract

The present study focuses on the evaluation of metal (chromium, copper, and lead), arsenic, and pesticide (atrazine and endosulfan) contamination in freshwater streams of one of the most important agricultural and industrial areas of central-eastern Argentina, which has not been reported earlier. The environmental fate of inorganic microcontaminants and pesticides was assessed. Samples were collected monthly for a year. Pesticide concentrations were measured in water; metal and arsenic concentrations were measured in water and sediments, and physicochemical variables were analyzed. In most cases, metals and arsenic in water exceeded the established guideline levels for the protection of aquatic biota: 98 and 56.25% of the samples showed higher levels of Cr and Pb, while 81.25 and 85% of the samples presented higher values for Cu and As, respectively. Cr, Pb, Cu, and As exceeded 181.5 times, 41.6 times, 57.5 times, and 12.9 times, respectively, the guideline level values. In sediment samples, permitted levels were also surpassed by 40% for Pb, 15% for As, 4% for Cu, and 2% for Cr. Geoaccumulation Index (Igeo) demonstrated that most of the sediment samples were highly polluted by Cr and Cu and very seriously polluted by Pb, which indicates progressive deterioration of the sediment quality. Atrazine never exceeded them, but 27% of the 48 water samples contained total endosulfan that surpassed the guidelines. The findings of this study suggest risk to the freshwater biota over prolong periods and possible risk to humans if such type of contaminated water is employed for recreation or human use. Improper disposal of industrial effluents and agricultural runoffs need to be controlled, and proper treatment should be done before disposal to avoid further deterioration of the aquifers of this area.



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Employing oxygen pulses to modulate Lachancea thermotolerans – Saccharomyces cerevisiae Chardonnay fermentations

Abstract

Oxygen is sometimes deliberately introduced in winemaking at various stages to enhance yeast biomass formation and prevent stuck fermentation. However, there is limited information on how such interventions affect the dynamics of yeast populations. Our previous study in synthetic grape juice showed that oxygen supply enhances the persistence of Lachancea thermotolerans, Torulaspora delbrueckii and Metschnikowia pulcherrima. The three non-Saccharomyces yeasts showed differences in growth as a function of oxygen. The present study focused on evaluating the influence of short oxygen pulses on population dynamics and the aroma profile of Chardonnay wine inoculated with L. thermotolerans and Saccharomyces cerevisiae. The results confirmed a positive effect of oxygen on the relative performance of L. thermotolerans. The mixed culture fermentation with L. thermotolerans with S. cerevisiae developed a distinct aroma profile when compared to monoculture S. cerevisiae. Specifically, a high concentration of esters, medium chain fatty acids and higher alcohols was detected in the mixed culture fermentation. The data also showed that the longer persistence of L. thermotolerans due to addition of oxygen pulses influenced the formation of major volatile compounds such as ethyl acetate, ethyl butyrate, ethyl hexanoate, ethyl caprylate, ethyl caprate, ethyl-3-hydroxybutanoate, ethyl phenylacetate, propanol, isobutanol, butanol, isoamyl alcohol, hexanol, isobutyric acid, butyric acid, iso-valeric acid, hexanoic acid, octanoic acid, and decanoic acid.



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Meta-ethnography to understand healthcare professionals experience of treating adults with chronic non-malignant pain

Objectives

We aimed to explore healthcare professionals’ experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care.

Design

Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals’ experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings.

Results

We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high.

Conclusions

This is the first qualitative evidence synthesis of healthcare professionals’ experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.



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Epidemiology of cancers in Lahore, Pakistan, among children, adolescents and adults, 2010-2012: a cross-sectional study part 2

Objectives

To estimate the cancer incidence by age group for the Lahore district population within the Punjab Cancer Registry (PCR), Pakistan. The average annual population of Lahore was 9.8 million in 2010–2012. This is a sequel to a study published earlier.

Design

A cross-sectional study.

Setting

The registry has 19 centres in Lahore reporting their data to the coordinating office located within the Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan.

Participants

Data existing in the PCR database, based on a confirmed diagnosis of cancer from 1 January 2010 to 31 December 2012, among the Lahore residents, were reviewed.

Outcome measures

Cancer counts and the age-standardised incidence rates (ASIR) per 100 000 population were computed by gender, cancer site/type and age group (0–14, 15–19 and ≥20 years).

Results

Between 2010 and 2012, of the 15 840 new cancers diagnosed, 57% were in females. The ASIRs in age groups 0–14, 15–19 and ≥20 years, among females, were: 6.1, 8.4 and 170.7, respectively, and among males, 9.3, 12.2 and 104.5, respectively. The common diagnoses in children, adolescents and adults were: (1) among females: leukaemia: 2.2; bone tumour: 1.4 and breast cancer: 79.2, respectively, and (2) among males: leukaemia: 3.6; bone tumour: 2.4 and prostate cancer: 10.7, respectively.

Conclusions

The ASIR was higher in adult women than in men, but it was lower in girls and young women than their corresponding male counterparts. Leukaemia was the most common diagnosis in children and bone tumour in adolescents, regardless of gender. Among women, breast cancer and, in men, prostate cancer, were the leading cancer types, in adults. These estimates could be used for the expansion of health coverage in the region including setting-up low cost, diagnostic tests for early detection of cancers.



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How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners

Objectives

Recent years have witnessed a progressive increase in defensive medicine (DM) in several Western welfare countries. In Danish primary and secondary care, documentation on the extent of DM is lacking. Before investigating the extent of DM, we wanted to explore how the phenomenon is understood and experienced in the context of general practice in Denmark. The objective of the study was to describe the phenomenon of DM as understood and experienced by Danish general practitioners (GPs).

Design

A qualitative methodology was employed and data were generated through six focus group interviews with three to eight GPs per group (n=28) recruited from the Region of Southern Denmark. Data were analysed using a thematic content analysis inspired by a hermeneutic-phenomenological focus on understanding and meaning.

Results

DM is understood as unnecessary and meaningless medical actions, carried out mainly because of external demands that run counter to the GP’s professionalism. Several sources of pressure to act defensively were identified by the GPs: the system’s pressure to meet external regulations, demands from consumerist patients and a culture among GPs and peers of infallibility and zero-risk tolerance.

Conclusions

GPs understand DM as unnecessary and meaningless actions driven by external demands instead of a focus on the patient’s problem. GPs consider defensive actions to be carried out as a result of succumbing to various sources of pressure deriving from the system, the patients, the GPs themselves and peers.



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Clinical efficacy and effectiveness of 3D printing: a systematic review

Objective

To evaluate the clinical efficacy and effectiveness of using 3D printing to develop medical devices across all medical fields.

Design

Systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Data sources

PubMed, Web of Science, OVID, IEEE Xplore and Google Scholar.

Methods

A double-blinded review method was used to select all abstracts up to January 2017 that reported on clinical trials of a three-dimensional (3D)-printed medical device. The studies were ranked according to their level of evidence, divided into medical fields based on the International Classification of Diseases chapter divisions and categorised into whether they were used for preoperative planning, aiding surgery or therapy. The Downs and Black Quality Index critical appraisal tool was used to assess the quality of reporting, external validity, risk of bias, risk of confounding and power of each study.

Results

Of the 3084 abstracts screened, 350 studies met the inclusion criteria. Oral and maxillofacial surgery contained 58.3% of studies, and 23.7% covered the musculoskeletal system. Only 21 studies were randomised controlled trials (RCTs), and all fitted within these two fields. The majority of RCTs were 3D-printed anatomical models for preoperative planning and guides for aiding surgery. The main benefits of these devices were decreased surgical operation times and increased surgical accuracy.

Conclusions

All medical fields that assessed 3D-printed devices concluded that they were clinically effective. The fields that most rigorously assessed 3D-printed devices were oral and maxillofacial surgery and the musculoskeletal system, both of which concluded that the 3D-printed devices outperformed their conventional comparators. However, the efficacy and effectiveness of 3D-printed devices remain undetermined for the majority of medical fields. 3D-printed devices can play an important role in healthcare, but more rigorous and long-term assessments are needed to determine if 3D-printed devices are clinically relevant before they become part of standard clinical practice.



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User involvement in adolescents mental healthcare: protocol for a systematic review

Introduction

User involvement has become a growing importance in healthcare. The United Nations state that adolescents have a right to be heard, and user involvement in healthcare is a legal right in many countries. Some research provides an insight into the field of user involvement in somatic and mental healthcare for adults, but little is known about user involvement in adolescents’ mental healthcare, and no overview of the existing research evidence exists.

Methods and analysis

The aim of this systematic review is to provide an overview of existing research reporting on experiences with and the effectiveness and safety issues associated with user involvement for adolescents’ mental healthcare at the individual and organisational level. A systematic literature search and assessment of published research in the field of user involvement in adolescents’ mental healthcare will be carried out. Established guidelines will be used for data extraction (Cochrane Collaboration guidelines, Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisal Skills Programme (CASP)), critical appraisal (Cochrane Collaboration guidelines and Pragmatic-Explanatory Continuum Indicator Summary) and reporting of results (Preferred Reporting Items for Systematic reviews and Meta-Analyses, Consolidated Standards of Reporting Trials and CASP). Confidence in the research evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Adolescents are included as coresearchers for the planning and carrying out of this systematic review. This systematic review will provide an overview of the existing research literature and thereby fill a knowledge gap. It may provide various stakeholders, including decision-makers, professionals, individuals and their families, with an overview of existing knowledge in an underexplored field of research.

Ethics and dissemination

Ethics approval is not required for this systematic review as we are not collecting primary data. The results will be published in a peer-reviewed journal and at conference presentations and will be shared with stakeholder groups.



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Associations of social environment, socioeconomic position and social mobility with immune response in young adults: the Jerusalem Perinatal Family Follow-Up Study

Objectives

Immune response to cytomegalovirus (CMV) impacts adult chronic disease. This study investigates associations of childhood and adulthood social environment, socioeconomic position (SEP) and social mobility with CMV response in young adults.

Design

Historical prospective study design.

Setting

Subcohort of all 17 003 births to residents of Jerusalem between 1974 and 1976.

Participants

Participants included 1319 young adults born in Jerusalem with extensive archival and follow-up data, including childhood and adulthood SEP-related factors and anti-CMV IgG titre levels and seroprevalence measured at age 32.

Main exposure and outcome measures

Principal component analysis was used to transform correlated social environment and SEP-related variables at two time points (childhood and adulthood) into two major scores reflecting household (eg, number of siblings/children, religiosity) and socioeconomic (eg, occupation, education) components. Based on these components, social mobility variables were created. Linear and Poisson regression models were used to investigate associations of components and mobility with anti-CMV IgG titre level and seroprevalence, adjusted for confounders.

Results

Lower levels of household and socioeconomic components in either childhood or adulthood were associated with higher anti-CMV IgG titre level and seropositivity at age 32. Compared with individuals with stable favourable components, anti-CMV IgG titre level and risk for seropositivity were higher in stable unfavourable household and socioeconomic components (household: β=3.23, P<0.001; relative risk (RR)=1.21, P<0.001; socioeconomic: β=2.20, P=0.001; RR=1.14, P=0.01), downward household mobility (β=4.32, P<0.001; RR=1.26, P<0.001) and upward socioeconomic mobility (β=1.37, P=0.04; RR=1.19, P<0.001). Among seropositive individuals, associations between household components and mobility with anti-CMV IgG titre level were maintained and associations between socioeconomic components and mobility with anti-CMV IgG titre level were attenuated.

Conclusions

Our study provides evidence that accumulating low SEP from childhood through adulthood and social mobility may compromise immune response in young adulthood.



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