Sulodexide in Patients with Chronic Venous Disease of the Lower Limbs: Clinical Efficacy and Impact on Quality of Life

Abstract

Introduction

Chronic venous disease (CVD) of the lower limbs is a common problem. It is more prevalent in women than in men and has a significant impact on patients' quality of life (QoL) and on the healthcare system. The aim of this study was to evaluate the efficacy of sulodexide in adult patients with CVD of the lower limbs and its effect on patients' QoL.

Methods

Patients with CVD were treated with sulodexide [250 LSU (lipasemic units) twice daily] for 3 months in a setting of real-life clinical practice. The endpoints of this observational non-comparative, open-label prospective study were the clinical efficacy of sulodexide (evaluated by scoring objective and subjective symptoms with a Likert-type scale) and the impact of sulodexide therapy on patients' QoL [assessed using the chronic venous insufficiency quality of life questionnaire (CIVIQ)].

Results

The study included 450 patients (mean age 46.9 ± 10.5 years, range 17–78 years). A greater percentage of patients were female (65.4%). Three months of treatment with sulodexide significantly improved all objective and subjective symptoms (p < 0.0001). Overall, patients reported a significant improvement in all QoL scores (p < 0.0001). Adverse events were spontaneously reported by two patients (one case of epigastric pain and one of gastric pain with vomiting).

Conclusion

Oral sulodexide significantly improves both objective and subjective symptoms, as well as functional and psychological aspects of QoL in patients with CVD.

Funding

No funding or sponsorship was received for this study. Sponsorship for article processing charges and open access fees was provided by Alfa Wassermann.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29xIdiL
via IFTTT

Assessment of Factors Related to the Understanding of Education and Knowledge of Self-Care among Patients with Diabetes Mellitus: A Cross-Sectional Prospective Study

Abstract

Introduction

The prevalence of diabetes mellitus is rapidly increasing particularly in developing countries. The aim of this study was to assess the knowledge and self-care practices of diabetes patients and to assess the contribution of the education to this knowledge level and glycemic control.

Methods

We formed patient groups consisting of 15–30 diabetic patients. First, patients were surveyed using a diabetes self-care knowledge questionnaire (DSCKQ-30). Sunsequently, a standard PowerPoint presentation about diabetes self-management was made to the patients who were then surveyed again using DSCKQ-30. All patients were invited to hospital to measure their control glycated hemoglobin (HbA1c) level 3 months later.

Results

Of the total 364 participants, 62.9% were females. Significant increases in the percentage of correct responses were determined in all components between, before and after education. There was a significant decline of 1.1 in HbA1c levels after 3 months of education. Married or active working patients had a better understanding of the education about diabetes and had a greater knowledge of self-care management regardless of their level of education or income.

Conclusion

Education about diabetes can significantly improve knowledge of self-care management and can help in achieving glycemic control. Continuing education about self-care management and complications is crucial and this should be accompanied by a regular assessment of pateients' diabetic knowledge.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yZiEK
via IFTTT

The long-term burden of severe sepsis and septic shock: Sepsis recidivism and organ dysfunction.

Background: Severe sepsis and septic shock mortality has improved, however rates of persistent (28 to 90 day) and long-term (>90 day) organ dysfunction in sepsis survivors are unknown. Methods: Secondary analysis of a prospective cohort of adult Emergency Department patients with severe sepsis. Results: Of 110 sepsis admissions, we obtained follow up on 51 of 78 survivors of whom 41% (21/51) had persistent organ dysfunction: pulmonary 18% (9/51), renal 22% (11/51), coagulopathy 10% (5/51), cardiovascular 6% (3/51), hepatic 2% (1/51), and neurologic 3% (3/51). We obtained follow up on 40 of 73 survivors at >90 days of whom 38% (15/40) had long-term organ dysfunction: pulmonary 13% (5/40), renal 18% (7/40), coagulopathy 3% (1/40), cardiovascular 5% (2/40), hepatic 0%, and neurologic 5% (2/40). Readmission rate within 90 days was 32% (25/78) and recurrent sepsis was the cause of readmission in 52% (13/25). Baseline SOFA scores from the index sepsis admission were compared using Wilcoxon's rank-sum test and were significantly different in participants with vs without organ dysfunction at

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zYkIg
via IFTTT

Prevalence and mortality of abdominal compartment syndrome in severely injured patients; A systematic review.

Background: Abdominal Compartment Syndrome (ACS) in severely injured patients is associated with high morbidity and mortality. Many efforts have been made to improve outcome of patients with ACS. A treatment algorithm for ACS patients was introduced on January 1, 2005 by the World Society of the Abdominal Compartment Syndrome (WSACS). The aim of this study was to determine the prevalence and mortality rate of ACS among severely injured patients before and after January 1, 2005 using a systematic literature review. Method: Databases of Embase, Medline (OvidSP), Web-of-science, CINAHL, CENTRAL, PubMed publisher and Google Scholar were searched for terms related to severely injured patients and ACS. Original studies reporting ACS in trauma patients were considered eligible. Data on study design, population, definitions, prevalence, and mortality rates were extracted. Pooled prevalence and mortality of ACS among severely injured patients were calculated for both time periods using inversed variance weighting assuming a random effects model. Tests for heterogeneity were applied. Results: A total of 80 publications were included. Prevalence of studies that finished enrolling patients before January 1, 2005 ranged from 0.5% to 36.4% and 0.0% to 28.0% in studies after that date. For severely injured patients admitted to the ICU this range was 0.5-1.3% before 2005 and 0% in one publication in the second time period. For patients with visceral injuries ACS prevalence ranged 1.0% to 20.0%, one study in the second time period reported 11.1%. The prevalence among severely injured patients who underwent trauma laparotomy ranged from 0.9% to 36.4% in the first time period. Two studies after January 1, 2005 reported ACS prevalence of 2.3% and 13.2%, respectively. The mortality rate in both time periods ranged between 0.0% and 100.0%. Conclusion: The overall prevalence of ACS ranged from 0.0% to 36.4%. Future studies are needed in order to measure the effect of improved trauma care and effectiveness of the WSACS Consensus Statements. Level of evidence: Level III Study type: Systematic Review (C) 2016 Lippincott Williams & Wilkins, Inc.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zYyiI
via IFTTT

Prise en charge des carcinomes neuroendocrines de prostate : revue de la littérature

Publication date: June 2016
Source:Cancer/Radiothérapie, Volume 20, Issue 4
Author(s): S. Yossi, T. Brahmi, C. Enachescu, I. Selmaji, A. Lapierre, H. Samlali, O. Chapet
Le carcinome neuroendocrine de la prostate est une entité rare posant des problèmes aussi bien diagnostiques que thérapeutiques. On distingue essentiellement quatre formes histologiques (les adénocarcinomes à différenciation neuroendocrine, les tumeurs carcinoïdes, les carcinomes à petites cellules, les carcinomes à grandes cellules), pouvant être pures ou mixtes, associées à un adénocarcinome prostatique. Il n'existe pas de consensus sur la prise en charge ni sur le pronostic de ces divers sous-types tumoraux. Nous avons effectué une revue de la littérature afin de déterminer les implications thérapeutiques potentielles.Neuroendocrine prostate carcinoma is a rare entity causing both diagnostic and therapeutic issues. There are basically four histological forms (adenocarcinoma with neuroendocrine differentiation, carcinoid tumors, small cell neuroendocrine carcinomas, large cell neuroendocrine carcinomas), which can be pure or mixed associated with prostatic carcinoma. There is no consensus on the management or the prognosis of these various tumor subtypes. We conducted a literature review aiming to determine the potential therapeutic implications.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEz5x
via IFTTT

Radiothérapie postopératoire des carcinomes médullaires de la thyroïde à haut risque de rechute locorégionale

Publication date: Available online 5 July 2016
Source:Cancer/Radiothérapie
Author(s): F. Compagnon, S. Zerdoud, M. Rives, A. Laprie, J. Sarini, S. Grunenwald, L. Chaltiel, P. Graff
ObjectifÉvaluer les résultats au long cours de la radiothérapie externe postopératoire des carcinomes médullaires de la thyroïde localement évolués.Patients et méthodesÉvaluation rétrospective et exhaustive des dossiers de 29 patients atteints d'un carcinome médullaire de la thyroïde traités dans notre service entre janvier 1995 et décembre 2012. Tous les patients avaient bénéficié d'une prise en charge à visée curative par une chirurgie carcinologique optimale, suivie d'une radiothérapie en raison d'un risque de rechute locorégionale jugé élevé. Douze cancers étaient de stade III, 16 de stade IVa et un de stade IVb. Les berges chirurgicales étaient envahies microscopiquement (R1) chez dix patients, macroscopiquement (R2) chez un. Les concentrations sériques médiane et moyenne de calcitonine avant la radiothérapie étaient respectivement de 141 et 699pg/mL. Le temps médian écoulé entre la chirurgie et la radiothérapie était de 1,9 mois. Quatorze patients ont été traités par irradiation conformationnelle tridimensionnelle et 15 par irradiation avec modulation d'intensité. La dose médiane délivrée était de 63Gy dans le volume à haut risque et de 54Gy dans celui à bas. Le traitement a été délivré en 30 séances. Le suivi médian était de 76,4 mois.RésultatsLes probabilités de survie globale et de survie sans rechute locorégionale à 5ans étaient respectivement de 96 et 79 %. Deux des cinq cas de rechute locorégionale s'expliquent a posteriori par la présence d'adénopathies macroscopiques résiduelles qui n'avaient pas été emportées par le curage ganglionnaire. Huit des dix cancers en résection R1 ont été durablement contrôlés dans le lit de thyroïdectomie. Sur les huit patients qui avaient normalisé leur calcitonine après l'association chirurgie et radiothérapie, un seul a vu se développer une rechute locorégionale. Sur les 21 patients chez qui persistait une calcitonine élevée après la radiothérapie, dix seulement été atteints de rechute macroscopique locorégionale et/ou à distance. Un seul cas de toxicité aiguë de grade III a été décrit, aucun de grade IV. Quinze patients ont rapporté une toxicité chronique de grade II mais aucun de grade III/IV.ConclusionUne chirurgie carcinologique maximale, suivie d'une radiothérapie adjuvante, assure des taux de contrôle locorégional à long terme et de survie globale élevés avec une faible toxicité chez des patients traités pour un carcinome médullaire de la thyroïde localement évolué. La radiothérapie externe postopératoire peut être considérée en cas de facteurs de risque de rechute locorégionale à l'analyse histologique.PurposeTo assess the outcome of locally advanced medullary thyroid carcinoma treated with surgery and adjuvant external beam radiotherapy.Patients and methodsTwenty-nine consecutive patients with non-metastatic medullary thyroid carcinoma treated in our institution between January 1995 and December 2012 were retrospectively evaluated. All underwent curative-intended optimal surgery, followed by external beam radiotherapy because of high risk of locoregional relapse. Twelve patients were stage III, 16 IVa and 1 IVb. Positive surgical margins were present in 11 cases (10 R1 and 1 R2). Median and average preradiotherapy serum calcitonin were 141pg/mL and 699pg/mL, respectively. Fourteen patients received 3D-conformal radiotherapy and 15 received intensity-modulated radiotherapy. Median prescribed dose was 63Gy to the high-risk volumes and 54Gy to the low-risk volumes. Treatment was delivered in 30 fractions. The median gap between surgery and radiotherapy was 1.9months. Median follow-up was 76.4months.ResultsKaplan-Meier estimates of 5-year locoregional relapse-free survival and overall survival were 79 and 96 %, respectively. Among the five locoregional relapses, two were related to a macroscopic metastatic cervical lymph node that was unfortunately not removed during the lymphadenectomy. Eight of ten patients with microscopic positive margins (R1) were controlled regarding the thyroidectomy bed. Eight patients had normal serum calcitonin after external beam radiotherapy, of whom only one developed a locoregional relapse during follow-up. Regarding the 21 patients with persistent positive serum calcitonin after treatment, only ten developed a macroscopic locoregional or distant relapse. One grade III and no grade IV acute morbidity were reported. Fifteen patients reported grade II chronic morbidity and no grade III/IV.ConclusionMaximal surgery followed by adjuvant external beam radiotherapy as a treatment for locally advanced medullary thyroid carcinoma provides a high rate of long-term locoregional control and overall survival with limited toxicity. Postoperative external beam radiotherapy should be considered when patients present features indicating a high risk of locoregional relapse.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yYQVK
via IFTTT

Prognostic significance of Livin expression in nasopharyngeal carcinoma after radiotherapy

Publication date: Available online 30 June 2016
Source:Cancer/Radiothérapie
Author(s): A.-H. Liu, A.-B. He, W.-X. Tong, X.-L. Peng, Q. Tian, H. Wang, X.-G. Li, H.-L. Xu
PurposeThis study was designed to investigate the expression levels of the inhibitor of apoptosis protein Livin in nasopharyngeal cancer tissues and its prognostic significance in nasopharyngeal carcinoma after radiotherapy.Material and methodsA total of 83 patients with nasopharyngeal carcinoma who received radiotherapy were enrolled in this study from January 2008 to October 2010. Livin expression in nasopharynx pathological specimens extracted from patients was detected by immunohistochemistry. A Kaplan-Meier analysis was conducted to explore the effects of clinicopathological features and Livin expression on the overall survival and progression-free survival of patients with nasopharyngeal carcinoma, and explore its prognosis relevance after radiotherapy.ResultsOf the 83 patients with nasopharyngeal carcinoma, the overall Livin positive expression rate was 65.1% (54 patients), and the overall response rate of radiotherapy was 81.9% (68 patients). Significant differences in radiotherapy efficacy were found between patients who did not express Livin and those who did (P<0.05). The Kaplan-Meier analysis showed that Livin expression, high clinical staging, cervical lymph node metastasis, high T-staging and high N-staging were significantly correlated with a decrease in the overall survival of patients with nasopharyngeal carcinoma (all P<0.05). A Cox multivariate survival analysis showed that Livin expression, clinical staging and N-staging were independent risk factors for the overall survival of patients with nasopharyngeal carcinoma treated with radiation (all P<0.05). Furthermore, Livin expression and clinical staging were independent risk factors for the progression-free survival of patients with nasopharyngeal carcinoma once radiotherapy was introduced (all P<0.05).ConclusionExpression of Livin, an inhibitor of apoptosis proteins, may be closely linked with poor prognosis of nasopharyngeal carcinoma post-radiotherapy and hence it may be a new therapeutic target in the treatment of the disease.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEf6D
via IFTTT

Correlation between radio-induced lymphocyte apoptosis measurements obtained from two French centres

Publication date: Available online 29 June 2016
Source:Cancer/Radiothérapie
Author(s): C. Mirjolet, J.L. Merlin, C. Dalban, P. Maingon, D. Azria
Purpose of the researchIn the era of modern treatment delivery, increasing the dose delivered to the target to improve local control might be modulated by the patient's intrinsic radio-sensitivity. A predictive assay based on radio-induced lymphocyte apoptosis quantification highlighted the significant correlation between CD4 and CD8 T-lymphocyte apoptosis and grade 2 or 3 radiation-induced late toxicities. By conducting this assay at several technical platforms, the aim of this study was to demonstrate that radio-induced lymphocyte apoptosis values obtained from two different platforms were comparable.Materials and methodsFor 25 patients included in the PARATOXOR trial running in Dijon the radio-induced lymphocyte apoptosis results obtained from the laboratory of Montpellier (IRCM, Inserm U1194, France), considered as the reference (referred to as Lab 1), were compared with those from the laboratory located at the Institut de cancérologie de Lorraine (ICL, France), referred to as Lab 2. Different statistical methods were used to measure the agreement between the radio-induced lymphocyte apoptosis data from the two laboratories (quantitative data). The Bland–Altman plot was used to identify potential bias.ResultsAll statistical tests demonstrated good agreement between radio-induced lymphocyte apoptosis values obtained from both sites and no major bias was identified.ConclusionsSince radio-induced lymphocyte apoptosis values, which predict tolerance to radiotherapy, could be assessed by two laboratories and showed a high level of robustness and consistency, we can suggest that this assay be extended to any laboratories that use the same technique.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yZS3W
via IFTTT

Prise en charge des carcinomes neuroendocrines de prostate : revue de la littérature

Publication date: June 2016
Source:Cancer/Radiothérapie, Volume 20, Issue 4
Author(s): S. Yossi, T. Brahmi, C. Enachescu, I. Selmaji, A. Lapierre, H. Samlali, O. Chapet




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEO0s
via IFTTT

Analysis of rare periparotid recurrence after parotid gland-sparing intensity-modulated radiotherapy for nasopharyngeal carcinoma

Publication date: Available online 29 June 2016
Source:Cancer/Radiothérapie
Author(s): Y. Xu, M. Zhang, Q. Yue, J. Zong, J. Lin, R. Sun, S. Qiu, S. Lin, J. Pan
PurposePeriparotid recurrence is an uncommon phenomenon after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma. This study aimed to discuss the clinical characteristics, reasonable causes and feasible therapeutic modalities of patients with nasopharyngeal carcinoma and periparotid recurrence.Patients and methodsThe medical records of 1852 patients with non-metastatic nasopharyngeal carcinoma treated with initial IMRT between January 2008 and December 2012 were retrospectively reviewed, and nine patients were finally found to have developed periparotid recurrence after IMRT. After periparotid failure, four received radiotherapy and chemotherapy, two had surgery, two had surgery and adjuvant radiotherapy or chemotherapy, and one received radiotherapy alone.ResultThe incidence rate of periparotid recurrence was 4.9‰. According to pretreatment magnetic resonance imaging (MRI) scans, all patients had both ipsilateral retropharyngeal lymph nodes metastasis with 66.7% of extracapsular spread and level II lymphadenopathy with all extracapsular spread. The median time interval to periparotid failure was 14.8 months, and six patients were found to have a relapse in the primary sites of unsuspicious parotid nodules. After a median follow-up of 46.4 months, five patients developed distant metastasis, three of them developed local failure. In addition, one developed regional failure, one developed locoregional recurrence, and only one was alive without evidence of disease at the last follow-up.ConclusionPeriparotid recurrences are rare after definitive IMRT for nasopharyngeal carcinoma. However, patients with ipsilateral retropharyngeal lymph nodes or level II nodal extracapsular spread on pretreatment MRI could be suspicious of metastatic periparotid nodules. Distant metastases were the main treatment failure despite a combination of several salvage treatment of periparotid recurrence. More effective chemotherapy should be explored.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yZwKP
via IFTTT

Comparison of dosimetric parameters and acute toxicity of intensity-modulated and three-dimensional radiotherapy in patients with cervix carcinoma: A randomized prospective study

Publication date: Available online 28 June 2016
Source:Cancer/Radiothérapie
Author(s): A. Naik, O.P. Gurjar, K.L. Gupta, K. Singh, P. Nag, V. Bhandari
PurposeThe use of intensity-modulated radiotherapy (IMRT) to treat cervix carcinoma has increased, however prospective randomized trials are still lacking.AimTo compare the dosimetric parameters and associated acute toxicity in patients with cervix carcinoma treated with three-dimensional (3D) conformal radiotherapy and IMRT.Patients and methodsForty patients were randomized in two arms each consisting of 20 patients. Patients in both arms received concurrent chemoradiation (cisplatin 40mg/m² weekly; 50Gy/25 fractions). Patients were treated with 3D conformal radiotherapy in one arm and with IMRT in another arm. After external beam radiotherapy, all patients received brachytherapy (21Gy/3 fractions at weekly interval). For dosimetric comparison, both kinds of the plans were done for all the patients. All patients were assessed throughout and until 90 days after completion of treatment for acute gastrointestinal, genitourinary and hematologic toxicities.ResultsBoth plans achieved adequate planning target volume coverage, while mean conformity index was found significantly better in IMRT plans (P-value=0.001). D35 (dose to 35% volume) and D50 for bladder was reduced by 14.62 and 32.57% and for rectum by 23.82 and 43.68% in IMRT. For IMRT, V45 (volume receiving 45Gy) of bowel were found significantly lesser (P-value=0.0001), non-tumour integral dose was found significantly higher (P-value=0.0240) and V20 of bone marrow was found significantly reduced (P-value=0.019) in comparison to that in 3D conformal radiotherapy. Significant reduction of grade 2 or more (20 vs 45%; P-value=0.058) and grade≥3 (5 vs 15%, P-value=0.004) acute genitourinary toxicity and grade 2 or more (20 vs 45%, P-value=0.003) and grade 3 or more (5 vs. 20%, P-value=0.004) acute gastrointestinal toxicity while no significant difference for grade 2 and 3 or more haematological toxicity was noted in patients treated with IMRT compared to 3D conformal radiotherapy.ConclusionIMRT provide a good alternative for treatment of cervix carcinoma with lower acute gastrointestinal and acute genitourinary toxicity with similar target coverage compared to 3D conformal radiotherapy.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEezE
via IFTTT

Feasibility evaluation of prone breast irradiation with the Sagittilt© system including residual-intrafractional error assessment

Publication date: Available online 5 July 2016
Source:Cancer/Radiothérapie
Author(s): F. Lakosi, A. Gulyban, S. Ben-Mustapha Simoni, P. Viet Nguyen, P. Berkovic, M. Noël, N. Gourmet, P. Coucke
PurposeFeasibility evaluation of the Sagittilt^© prone breast board system (Orfit Industries, Wijnegem, Belgium) for radiotherapy focusing on patient and staff satisfaction, treatment time, treatment reproducibility with the assessment of residual-intrafractional errors.Material and methodsThirty-six patients underwent whole-breast irradiation in prone position. Seventeen received a sequential boost (breast: 42.56Gy in 16 fractions, boost: 10Gy in five fractions), while 19 patients received a concomitant boost protocol (breast/boost: 45.57/55.86Gy in 21 fractions). Treatment verification included a daily online cone-beam CT (CBCT). In order to assess the residual and residual-intrafractional errors post-treatment CBCTs were performed systematically at the first five treatment sessions. Treatment time, patient comfort, staff satisfaction were also evaluated.ResultsThe pretreatment CBCT resulted in a population systematic error of 4.5/3.9/3.3mm in lateral/longitudinal/vertical directions, while the random error was 5.4/3.8/2.8mm. Without correction these would correspond to a clinical to planning target volume margin of 15.0/12.3/10.3mm. The population systematic and random residual-intrafractional errors were 1.5/0.9/1.7mm and 1.7/1.9/1.6mm. Patient and staffs' satisfaction were considered good and average. The mean treatment session time was 21minutes (range: 13–40min).ConclusionThe Sagittilt^© system seems to be feasible for breast irradiation and well-tolerated by patients, acceptable to radiographers and reasonable in terms of treatment times. Set-up accuracy was comparable with other prone systems; residual errors need further investigations.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yYZbL
via IFTTT

Risques cardiovasculaires avec les hormonothérapies pour cancer de la prostate : rationnel pour une unité oncocardiologique

Publication date: Available online 23 June 2016
Source:Cancer/Radiothérapie
Author(s): I. Latorzeff, G. Ploussard, J. Guillotreau, F. Jonca, P. Labarthe, G. Rollin, J.-B. Beauval, A. Pathak




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEJcQ
via IFTTT

L’énigme de l’interprétation biologique du modèle linéaire-quadratique enfin résolue ? Une synthèse pour les non-mathématiciens

Publication date: June 2016
Source:Cancer/Radiothérapie, Volume 20, Issue 4
Author(s): L. Bodgi, A. Canet, A. Granzotto, M. Britel, A. Puisieux, M. Bourguignon, N. Foray
Le modèle linéaire-quadratique (LQ) est aujourd'hui la seule relation mathématique liant la survie cellulaire et la dose de radiation qui soit suffisamment consensuelle pour que radiothérapeutes et radiobiologistes l'utilisent régulièrement dans leurs interprétations des phénomènes radioinduits. Pourtant, cette formule proposée dans les années 1970 et les paramètres α et β sur lesquels elle est basée sont restés sans signification biologique cohérente. À partir d'une collection de fibroblastes cutanés de radiosensibilité différente constituée pendant 12ans par plus de 50 radiothérapeutes français, nous avons mis récemment en évidence que la protéine ATM, acteur majeur de la réponse aux radiations ionisantes, diffuse du cytoplasme au noyau après irradiation. La mise en évidence de ce transit cytonucléaire de la protéine ATM nous a permis de fournir une interprétation biologique cohérente du modèle linéaire-quadratique dans ses aspects les plus mathématiques, validée par une centaine de cas. Une explication mécanistique de la radiosensibilité des syndromes causés par des mutations de protéines cytoplasmiques et du phénomène d'hypersensibilité aux faibles doses a pu être aussi avancée. Dans cette revue, nous avons abordé la résolution de ce modèle linéaire-quadratique de façon didactique, en se limitant strictement aux aspects mathématiques les plus essentiels.The linear-quadratic (LQ) model is the only mathematical formula linking cellular survival and radiation dose that is sufficiently consensual to help radiation oncologists and radiobiologists in describing the radiation-induced events. However, this formula proposed in the 1970s and α and β parameters on which it is based remained without relevant biological meaning. From a collection of cutaneous fibroblasts with different radiosensitivity, built over 12 years by more than 50 French radiation oncologists, we recently pointed out that the ATM protein, major actor of the radiation response, diffuses from the cytoplasm to the nucleus after irradiation. The evidence of this nuclear shuttling of ATM allowed us to provide a biological interpretation of the LQ model in its mathematical features, validated by a hundred of radiosensitive cases. A mechanistic explanation of the radiosensitivity of syndromes caused by the mutation of cytoplasmic proteins and of the hypersensitivity to low-dose phenomenon has been proposed, as well. In this review, we present our resolution of the LQ model in the most didactic way.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yZ4MO
via IFTTT

Toxicity and efficacy of cetuximab associated with several modalities of IMRT for locally advanced head and neck cancer

Publication date: Available online 23 June 2016
Source:Cancer/Radiothérapie
Author(s): J.-E. Bibault, M. Morelle, L. Perrier, P. Pommier, P. Boisselier, B. Coche-Dequéant, O. Gallocher, M. Alfonsi, É. Bardet, M. Rives, V. Calugaru, E. Chajon, G. Noël, H. Mecellem, D. Pérol, S. Dussart, P. Giraud
PurposeIntensity-modulated radiation therapy (IMRT) has shown its interest for head and neck cancer treatment. In parallel, cetuximab has demonstrated its superiority against exclusive radiotherapy. The objective of this study was to assess the acute toxicity, local control and overall survival of cetuximab associated with different IMRT modalities compared to platinum-based chemotherapy and IMRT in the ARTORL study (NCT02024035).Patients and methodThis prospective, multicenter study included patients with epidermoid or undifferentiated nasopharyngeal carcinoma, epidermoid carcinoma of oropharynx and oral cavity (T1–T4, M0, N0–N3). Acute toxicity, local control and overall survival were compared between groups (patients receiving cetuximab or not). Propensity score analysis at the ratio 1:1 was undertaken in an effort to adjust for potential bias between groups due to non-randomization.ResultsFrom the 180 patients included in the ARTORL study, 29 patients receiving cetuximab and 29 patients treated without cetuximab were matched for the analysis. Ten patients (34.5%) reported acute dermal toxicity of grade 3 in the cetuximab group versus three (10.3%) in the non-cetuximab group obtained after matching (P=0.0275). Cetuximab was not significantly associated with more grade 3 mucositis (P=0.2563). There were no significant differences in cutaneous or oral toxicity for patients treated with cetuximab between the different IMRT modalities (P=1.000 and P=0.5731, respectively). There was no significant difference in local relapse-free survival (P=0.0920) or overall survival (P=0.4575) between patients treated with or without cetuximab.ConclusionPatients treated with cetuximab had more cutaneous toxicities, but oral toxicity was similar between groups. The different IMRT modalities did not induce different toxicity profiles.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEqit
via IFTTT

Prise en charge des carcinomes neuroendocrines de prostate : revue de la littérature

Publication date: June 2016
Source:Cancer/Radiothérapie, Volume 20, Issue 4
Author(s): S. Yossi, T. Brahmi, C. Enachescu, I. Selmaji, A. Lapierre, H. Samlali, O. Chapet




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yZ4wi
via IFTTT

Bénéfice attendu du curage ganglionnaire et de l’exérèse des vésicules séminales pour diminuer la toxicité de la radiothérapie des tumeurs prostatiques de haut risque

Publication date: Available online 22 June 2016
Source:Cancer/Radiothérapie
Author(s): J. Colliaux, L. Kharchi, S. Vincendeau, A. Simon, M. Perdrieux, É. Le Prisé, É. Bellisant, J. Castelli, R. de Crevoisier
Objectif de l'étudeEn cas de radiothérapie prostatique avec modulation d'intensité (RCMI), précédée d'une chirurgie première par curage ganglionnaire pelvien et exérèse des vésicules séminales, l'objectif de l'étude était d'évaluer le bénéfice dosimétrique d'une réduction du volume cible.Patients et méthodesVingt-cinq patients atteints d'un cancer de prostate de haut risque ont eu une chirurgie première suivie d'une RCMI prostatique et d'une hormonothérapie. Quatre plans de traitement ont été simulés pour chaque patient, à partir des scanographies réalisées avant et après la chirurgie et correspondant aux volumes cibles suivants : prostate–vésicules séminales–aires ganglionnaires pelviennes, prostate–aires ganglionnaires pelviennes, prostate–vésicules séminales, et prostate seule. La dose totale délivrée aux aires ganglionnaires pelviennes et aux vésicules séminales était de 46Gy, et celle à la prostate de 80Gy.RésultatsL'addition des vésicules séminales puis des aires ganglionnaires pelviennes multipliait respectivement par 1,6 et 6,5 le volume cible prévisionnel. La réduction progressive du volume cible prévisionnel « prostate–vésicules séminales–ganglions pelviens » à « prostate–vésicules séminales » puis à « prostate seule » conduisait à une diminution de la dose moyenne dans la paroi rectale de 49Gy à 42Gy puis à 36Gy, et du risque prédit de rectorragies tardives de 4,4 % à 3,2 % puis à 2,4 % (p<0,05). La dose moyenne dans la paroi vésicale diminuait de 51Gy à 40Gy puis à 35Gy (p<0,05). Pour ce qui concerne l'intestin grêle, l'absence d'irradiation des aires ganglionnaires pelviennes réduisait le risque de diarrhées aiguës de 11 % en valeur absolue.ConclusionUne chirurgie première avec curage et exérèse des vésicules séminales avant la RCMI conduit probablement à une diminution modérée de la toxicité digestive.PurposeIn case of pelvic lymph node and seminal vesicle dissection followed by prostate cancer intensity-modulated radiotherapy, the objective of the study was to evaluate the dosimetric benefit of reducing the target volume.Patients and methodsA total of 25 patients with high-risk prostate cancer had surgery first followed by intensity-modulated radiotherapy and androgen deprivation. Four treatment planning were simulated for each patient, based on two CT scans performed before and after surgery. The target volumes were: prostate–seminal vesicles–lymph nodes, prostate–lymph nodes, prostate–seminal vesicles and prostate only. The total dose was 46Gy in the seminal vesicles and lymph nodes, and 80Gy in the prostate.ResultsCompared to prostate target volume only, the addition of seminal vesicles and lymph nodes multiplied by a factor of 1.6 and 6.5 the target volume, respectively. Decreasing the target volume from prostate–seminal vesicles–lymph nodes to prostate–seminal vesicles, to prostate only decreased the rectal wall mean dose from 49Gy to 42Gy, to 36Gy, and the risk of late rectal bleeding from 4.4% to 3.2%, to 2.4% (P<0.05), respectively. The bladder wall mean dose decreased from 51Gy to 40Gy, to 35Gy (P<0,05), respectively. Not irradiating the lymph nodes decreased the absolute risk of diarrhea by 11%.ConclusionLymph node and seminal vesicle dissection before prostate cancer intensity-modulated radiotherapy allows decreasing moderately the risk of digestive toxicity.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CEcHV
via IFTTT

Risques cardiovasculaires avec les hormonothérapies pour cancer de la prostate : rationnel pour une unité oncocardiologique

Publication date: Available online 22 June 2016
Source:Cancer/Radiothérapie
Author(s): I. Latorzeff, G. Ploussard, J. Guillotreau, F. Jonca, P. Labarthe, G. Rollin, J.-B. Beauval, A. Pathak
Le cancer de la prostate, le plus fréquent des cancers chez l'homme, est un adénocarcinome sensible, dans plus de 80 % des cas, à la castration chimique, en raison de son hormonodépendance. L'hormonothérapie androgénosuppressive est le traitement des formes évoluées du cancer et peut être associée à la radiothérapie en évoluée. Le choix thérapeutique, pluridisciplinaire, est fondé sur l'âge et les maladies associées du patient, et le stade clinique. L'impact de l'hormonothérapie confère au patient des effets secondaires variés et ceux cardiovasculaires sont maintenant mieux connus. Les mécanismes responsables de cette cardiotoxicité sont à la fois directs et indirects par effets métaboliques thermogéniques. L'analyse de ces effets cliniques ou biologiques, leurs corrélations au type d'hormonothérapie utilisé et les précautions possibles de prescription seront détaillés dans cette synthèse de la littérature. La collaboration du cancérologue ou de l'urologue avec le cardiologue devient nécessaire et l'existence d'une unité d'oncocardiologie pourrait améliorer l'évaluation de la balance bénéfice–risque et la tolérance du traitement.Prostate cancer, the most frequent cancer in man, is an adenocarcinoma sensible to chemical castration in more than 80% of cases due to its hormonal dependency. Androgen deprivation is the treatment for advanced cancer and can be associated with radiotherapy locally or in locally advanced situations. Multidisciplinary therapeutic choice depends on patient age and co-morbidities and clinical stage. The impact of hormonal treatment confers varied side effects and cardiovascular effects are now better known. Responsible mechanisms of this cardiotoxicity are at the same time direct but also indirect by metabolic thermogenic effects. Analysis of these clinical or biological effects, their correlations to the used type of hormonal treatment and the possible precautions of prescription will be detailed in this analysis of the literature. The collaboration of the oncologist or the urologist with the cardiologist becomes necessary and the existence of a unit of oncocardiology could improve the evaluation of the risk–benefit balance and the tolerance of the treatment.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yZ4fM
via IFTTT

Using Best–Worst Scaling to Investigate Preferences in Health Care

Abstract

Introduction

Best–worst scaling (BWS) is becoming increasingly popular to elicit preferences in health care. However, little is known about current practice and trends in the use of BWS in health care. This study aimed to identify, review and critically appraise BWS in health care, and to identify trends over time in key aspects of BWS.

Methods

A systematic review was conducted, using Medline (via Pubmed) and EMBASE to identify all English-language BWS studies published up until April 2016. Using a predefined extraction form, two reviewers independently selected articles and critically appraised the study quality, using the Purpose, Respondents, Explanation, Findings, Significance (PREFS) checklist. Trends over time periods (≤2010, 2011, 2012, 2013, 2014 and 2015) were assessed further.

Results

A total of 62 BWS studies were identified, of which 26 were BWS object case studies, 29 were BWS profile case studies and seven were BWS multi-profile case studies. About two thirds of the studies were performed in the last 2 years. Decreasing sample sizes and decreasing numbers of factors in BWS object case studies, as well as use of less complicated analytical methods, were observed in recent studies. The quality of the BWS studies was generally acceptable according to the PREFS checklist, except that most studies did not indicate whether the responders were similar to the non-responders.

Conclusion

Use of BWS object case and BWS profile case has drastically increased in health care, especially in the last 2 years. In contrast with previous discrete-choice experiment reviews, there is increasing use of less sophisticated analytical methods.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29tEgWw
via IFTTT

ARIES M1, a New Compact Clinical Real-Time PCR System

Luminex won clearance from the FDA and European CE-IVD mark of approval to introduce its ARIES M1 real-time PCR system. Designed for smaller clinical labs, the M1 is a lower throughput version of the company's ARIES system, offering essentially the same features in a smaller package.

It can run six samples and up to six different assays simultaneously, extracting, amplifying, and detecting genetic material all on its own once the cartridges are loaded.

"In developing the ARIES family of systems, we listened closely to the needs of our customers and crafted these products to increase laboratory efficiency, ensure result accuracy, and fit seamlessly into today's lean laboratory. We are now adding another system based on customer feedback, and in doing so, expanding our market reach," said Homi Shamir, President and CEO of Luminex in a statement. "Luminex now has the broadest offering of low-plex and high-plex sample to answer systems for clinical laboratories performing molecular diagnostic testing. And, with the acquisition of NSPH behind us, we can focus on continuing to move products in our pipeline towards commercialization and realizing the value in our newly acquired asset."

Product page: ARIES…

Source: Luminex Corporation…

This post ARIES M1, a New Compact Clinical Real-Time PCR System appeared first on Medgadget.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29I6DUH
via IFTTT

Smarte Funduskopie

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29tEeha
via IFTTT

Title

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zRCC6
via IFTTT

Declarative association in the perirhinal cortex

Publication date: Available online 11 July 2016
Source:Neuroscience Research
Author(s): Yuji Naya
Declarative memories are our so-called daily language memories, which we are able to describe or explicitly experience through the act of remembering. This conscious recollection makes it possible for us to think about the future based on our previous experience (episodic memory) and knowledge (semantic memory). This cognitive function is substantiated by the medial temporal lobe (MTL), a hierarchically organized complex in which the perirhinal cortex and parahippocampal cortex provide item and context information to the hippocampus via the entorhinal cortex, and the hippocampus plays the main role in association and recollection. This conventional view provides an easily understood structure to the declarative memory system. However, neurophysiological studies reporting the activities of single neurons bring a more complicated view. In this article, I review single-unit studies, particularly those focused on the perirhinal cortex and hippocampus, and suggest that association processes for declarative memory are more distributed over the MTL areas. The perirhinal cortex represents both between-domain associations (e.g., item-reward, item-place and item-time) and within-domain associations (e.g., item-item) and contributes to both subcategories of declarative memory (i.e., episodic and semantic memory) in a way that is complementary with the hippocampus.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29KmiSd
via IFTTT

Neighborhood linking social capital as a predictor of drug abuse: A Swedish national cohort study

Publication date: December 2016
Source:Addictive Behaviors, Volume 63
Author(s): Jan Sundquist, Cecilia Sjöstedt, Marilyn Winkleby, Xinjun Li, Kenneth S. Kendler, Kristina Sundquist
AimsThis study examines the association between the incidence of drug abuse (DA) and linking (communal) social capital, a theoretical concept describing the amount of trust between individuals and societal institutions.MethodsWe present results from an 8-year population-based cohort study that followed all residents in Sweden, aged 15–44, from 2003 through 2010, for a total of 1,700,896 men and 1,642,798 women. Linking social capital was conceptualized as the proportion of people in a geographically defined neighborhood who voted in local government elections. Multilevel logistic regression was used to estimate odds ratios (ORs) and between-neighborhood variance.ResultsWe found robust associations between linking social capital and DA in men and women. For men, the OR for DA in the crude model was 2.11 [95% confidence interval (CI) 2.02–2.21] for those living in neighborhoods with the lowest vs. highest level of social capital. After accounting for neighborhood level deprivation, the OR fell to 1.59 (1.51–1-68). The ORs remained significant after accounting for age, family income, marital status, country of birth, education level, and region of residence, and after further accounting for comorbidities and family history of comorbidities and family history of DA. For women, the OR decreased from 2.15 (2.03–2.27) in the crude model to 1.31 (1.22–1.40) in the final model, adjusted for multiple neighborhood-level, individual-level variables, and family history for DA.ConclusionsOur study suggests that low linking social capital may have significant independent effects on DA.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yRYYJ
via IFTTT

Title

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zRCC6
via IFTTT

Pokemon Go leads to body in river

A woman playing the game was led to a river, where a body was found. Read the full story .

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29sVS5H
via IFTTT

Title

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zRCC6
via IFTTT

Pokemon Go leads to body in river

A woman playing the game was led to a river, where a body was found. Read the full story .

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29sVS5H
via IFTTT

Prevention of Heat Stress Adverse Effects in Rats by Bacillus subtilis Strain

We described a protocol for prevention of heat stress effects in rats by oral pre-treatment with beneficial bacteria. This protocol can be modified and used for various routes of administration and for analysis of different compounds.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29IN6oz
via IFTTT

Identification of Rare Bacterial Pathogens by 16S rRNA Gene Sequencing and MALDI-TOF MS

Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) and molecular techniques (16S rRNA gene sequencing) permit the identification of rare bacterial pathogens in routine diagnostics. The goal of this protocol lies in the combination of both techniques which leads to more accurate and reliable data.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29IML5y
via IFTTT

An Elusive Vinyl Radical Isolated as an Appended Unit in a Five-Coordinate Co(III)-Bis(Iminobenzosemiquinone) Complex Formed via Ligand-Centered C-S Bond Cleavage

Chem. Commun., 2016, Accepted Manuscript
DOI: 10.1039/C6CC02751B, Communication

Chandan Mukherjee, Prasenjit Sarkar, Archana Tiwari, Amrit Sarmah, Ram Kinkar Roy, Subhrajyoti Bhandary
Redox˗active ligand H4Praedt(AP/AP) experienced C-S bond cleavage during complexation reaction with Co(OAc)2[round bullet, filled]2H2O in the presence of Et3N in CH3OH under air. Thus, formed complex 1 was comprised of two iminobenzosemiquinone...
The content of this RSS Feed (c) The Royal Society of Chemistry

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29KrVPE
via IFTTT

Carbon dioxide capture strategies from flue gas using microalgae: a review

Abstract

Global warming and pollution are the twin crises experienced globally. Biological offset of these crises are gaining importance because of its zero waste production and the ability of the organisms to thrive under extreme or polluted condition. In this context, this review highlights the recent developments in carbon dioxide (CO₂) capture from flue gas using microalgae and finding the best microalgal remediation strategy through contrast and comparison of different strategies. Different flue gas microalgal remediation strategies discussed are as follows: (i) Flue gas to CO₂ gas segregation using adsorbents for microalgal mitigation, (ii) CO₂ separation from flue gas using absorbents and later regeneration for microalgal mitigation, (iii) Flue gas to liquid conversion for direct microalgal mitigation, and (iv) direct flue gas mitigation using microalgae. This work also studies the economic feasibility of microalgal production. The study discloses that the direct convening of flue gas with high carbon dioxide content, into microalgal system is cost-effective.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29GBK2T
via IFTTT

Desalination of sea water with aquatic lily ( Eichhornia crassipes )

Abstract

During the last decades, methods of halo conditioning have been developed to increase the tolerance to salinity in glucophyta crops. Some experiments have carried out the application of hydrogen peroxide (H₂O₂), in support to the modification of cell tolerance in saline medium. The first objective of this study was to evaluate the effects of the incorporation of H₂O₂ in salinity tolerance development of the aquatic lily (Eichhornia crassipes). Results showed that the incorporation of 0.03 % H₂O₂ salinity tolerance developed in salt concentrations similar to seawater. Saline stress tolerance in aquatic lily was shown by the excretion of salts in its leaves; this process helped also in removing salt from seawater. At the same time, the reproduction of the lily is intimately linked to the content of nitrogen (N) and phosphorus (P) (nutrients) in water. This reason is important to control the concentrations of these elements in the water. This will allow maintaining a control in the dissemination of the lily. Considering the mentioned above, the second objective was to continue development of the adaptation of the aquatic lily in seawater, using H₂O₂ and the required amount of nutrients. This paper points out the importance of considering a biological process for the treatments in the desalination of seawater, making the process more sustainable.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29HWBCN
via IFTTT

Analysis of energy-related CO 2 emissions and driving factors in five major energy consumption sectors in China

Abstract

Continual growth of energy-related CO₂ emissions in China has received great attention, both domestically and internationally. In this paper, we evaluated the CO₂ emissions in five major energy consumption sectors which were evaluated from 1991 to 2012. In order to analyze the driving factors of CO₂ emission change in different sectors, the Kaya identity was extended by adding several variables based on specific industrial characteristics and a decomposition analysis model was established according to the LMDI method. The results demonstrated that economic factor was the leading force explaining emission increase in each sector while energy intensity and sector contribution were major contributors to emission mitigation. Meanwhile, CO₂ emission intensity had no significant influence on CO₂ emission in the short term, and energy consumption structure had a small but growing negative impact on the increase of CO₂ emissions. In addition, the future CO₂ emissions of industry from 2013 to 2020 under three scenarios were estimated, and the reduction potential of CO₂ emissions in industry are 335 Mt in 2020 under lower-emission scenario while the CO₂ emission difference between higher-emission scenario and lower-emission scenario is nearly 725 Mt. This paper can offer complementary perspectives on determinants of energy-related CO₂ emission change in different sectors and help to formulate mitigation strategies for CO₂ emissions.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29snrLC
via IFTTT

(Anti-)estrogenic and (anti-)androgenic effects in wastewater during advanced treatment: comparison of three in vitro bioassays

Abstract

Endocrine-disrupting chemicals are mainly discharged into the environment by wastewater treatment plants (WWTPs) and are known to induce adverse effects in aquatic life. Advanced treatment with ozone successfully removes such organic micropollutants, but an increase of estrogenic effects after the ozonation of hospital wastewater was observed in previous studies. In order to investigate this effect, estrogenic and androgenic as well as anti-estrogenic and anti-androgenic activities were observed during treatment of hospital wastewater using three different effect-based reporter gene bioassays. Despite different matrix influences, sensitivities, and test-specific properties, all assays used obtained comparable results. Estrogenic and androgenic activities were mainly reduced during the biological treatment and further removed during ozonation and sand filtration, resulting in non-detectable agonistic activities in the final effluent. An increased estrogenic activity after ozonation could not be observed in this study. Antagonistic effects were removed in the biological treatment by up to 50 % without further reduction in the advanced treatment. Due to the presence of antagonistic substances within the wastewater, masking effects were probable. Therefore, this study showed the relevance of antagonistic activities at hospital WWTPs and illustrates the need for a better understanding about antagonistic effects.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29snve4
via IFTTT

Characterising the hydrological regime of an ungauged temporary river system: a case study

Abstract

Temporary streams are characterised by specific hydrological regimes, which influence ecosystem processes, groundwater and surface water interactions, sediment regime, nutrient delivery, water quality and ecological status. This paper presents a methodology to characterise and classify the regime of a temporary river in Southern Italy based on hydrological indicators (HIs) computed with long-term daily flow records. By using a principal component analysis (PCA), a set of non-redundant indices were identified describing the main characteristics of the hydrological regime in the study area. The indicators identified were the annual maximum 30- and 90-day mean (DH4 and DH5), the number of zero flow days (DL6), flow permanence (MF) and the 6-month seasonal predictability of dry periods (SD6). A methodology was also tested to estimate selected HIs in ungauged river reaches. Watershed characteristics such as catchment area, gauging station elevation, mean watershed slope, mean annual rainfall, land use, soil hydraulic conductivity and available water content were derived for each site. Selected indicators were then linked to the catchment characteristics using a regression analysis. Finally, MF and SD6 were used to classify the river reaches on the basis of their degree of intermittency. The methodology presented in this paper constitutes a useful tool for ecologists and water resource managers in the Water Framework Directive implementation process, which requires a characterisation of the hydrological regime and a 'river type' classification for all water bodies.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29GC8OZ
via IFTTT

Disfiguring Giant Odontogenic Myxoma of Mandible: A Case Report with Brief Review of Literature

Abstract

Odontogenic myxoma is an uncommon benign but locally aggressive tumor which exclusively arises from tooth bearing areas. We are reporting a case of a giant slow growing odontogenic myxoma of mandible in a 16-year-old girl causing significant functional and cosmetic problem. Giant size of the tumor has caused facial disfigurement, mental agony and foul smell, because of which the patient confined herself in the house and lived the reclusive social life. Tumor was widely excised and reconstruction done with titanium plate.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yJXbg
via IFTTT

Point-of-care tests reduce antibiotic use for acute respiratory infections

- Kenny Lin, MD, MPH

In last week's blog post, Dr. Jennifer Middleton discussed the strengths and limitations of rapid strep testing for patients with acute sore throats. In patients with an intermediate pre-test probability of having streptococcal pharyngitis, a negative rapid strep test lowers the post-test probability enough to feel comfortable withholding antibiotics. Wouldn't it be nice if other point-of-care tests could effectively rule out bacterial infections and reduce antibiotic prescribing rates in patients with acute respiratory symptoms?

A FPIN Clinical Inquiry published in the July 1st issue of AFP evaluated the effects of a procalcitonin-guided antibiotic therapy algorithm on antibiotic use and clinical outcomes. A Cochrane review and meta-analysis of 14 randomized, controlled trials (RCTs) comparing procalcitonin-guided to standard care in European adults with acute respiratory infections found that patients in the procalcitonin group received 3.47 fewer days of antibiotic therapy with no differences in 30-day mortality or treatment failure. In a single RCT of 337 children presenting to pediatric emergency departments in Switzerland, patients in the procalcitonin group were as likely as the standard care group to receive antibiotic prescriptions, but received nearly 2 fewer days of therapy.

A 2015 Cochrane for Clinicians examined the performance of point-of-care measurement of C-reactive protein (CRP) on similar outcomes. Although treatment thresholds varied, most studies considered a CRP level of less than 20 mg per L to suggest a viral infection and no need for antibiotics. A Cochrane review of 6 RCTs conducted in primary care settings (mostly in adults) in Europe and Russia found that groups assigned to CRP-assisted evaluation were 22 percent less likely to receive antibiotic prescriptions for acute respiratory infections, with no differences in clinical improvement at day 7, complications, or mortality. However, Dr. Irbert Vega observed in the Practice Pointers that "the meta-analysis did not identify an optimal algorithm and therefore should be considered proof of concept until further research can be performed, including research in the U.S. population."

Upcoming editorials and features in AFP will discuss the effectiveness of other interventions aimed at reducing unnecessary antibiotic use for respiratory infections in primary care settings, including those evaluated in a recent systematic review from the Agency for Healthcare Research and Quality.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zMWMA
via IFTTT

The EMS confession that's going viral: 'This is hard'

Anyone who is involved with the EMS profession understands the toll it can take on its workers. 

In the wake of last Thursday's shootings in Dallas, an anonymous Imgur user writing as an EMT penned an open letter about the challenges and emotional burdens associated with being a first responder.

"I've seen people so up in arms about the very unfortunate deaths that have happened here over the last 3 or 4 days. And it hurts so much to see people willing to divide themselves over what has been going on," he writes, "It stuns me that its [sic.] so easy for humans to be so willing to say someone deserves death."

"I'm tired of watching the world be so willing to damn people to death based on their job, race, religion, or what the hell ever. If you are willing to think that thought, you don't value human life," he added.

"We give up holidays with our families to be with yours. Because you need us. "We might bitch and moan about having to be up in the wee hours of the morning. But the truth is, we wouldn't do anything else."

The post has since been viewed over 5 million times. Of the more than 1,000 user comments posted, the top-ranking comments are overwhelmingly positive.

"I think this is the most meaningful thing I've read in a very, very long time," wrote one user.

I've been contemplating for a couple of days about making a post to inform people of EMS and what we really do. But I cant. After these events the passed few days I've been unable to bring myself to make it. The reason is, I've seen people so up in arms about the very unfortunate deaths that have happened here over the last 3 or 4 days. And I get it, more than you could possibly know. And it hurts so much to see people willing to divide themselves over what has been going on. It makes my heart heavy. It stuns me that its so easy for humans to be so willing to say someone deserves death.We are tired of going to work. We are tired of being called to an apartment at 4 in the morning to someone who has been shot 6 times over piddly shit. What's even more tiring is when we sit there and do everything we can to try and give this person another go at life, but we watch life actually leave this person and he ceases to exist. We are tired of having to tell families that we did everything we possibly could have (and the entire time knowing that, telling them this, it doesn't change a thing) but their loved one has passed away. We are tired of hearing children crying because they're afraid of losing their parent. We are tired of going to funerals for people we know and have become friends with, who lost their life doing their job. We are tired of seeing everyday people lose their loved ones because of some kind of violence that is solely because one street doesn't like another. We are tired of seeing violence in the street because everyday we know someone else is going to lose their life over meaningless "turf". We are tired of seeing how drugs can destroy a family, a neighborhood, and even an entire city.But no matter how tired we get, we still wake up. We get dressed and we walk out the front door. We get on our trucks and we sit next to a person who is probably equally as tired as the rest of us. We don't do it for the money because believe me, we don't make a lot. We wake up every day because, if it was our parents or children out there dying, we would want someone there to help us. We know that we are seeing you on the worst day of your life. We know that you are in the most pain you've ever been in. We know what its like to lose people, because we do it more often than you do. We have held the hand of people as they take their last breath. We have been the last kind face countless people have ever seen. We have held crying mothers, fathers, and children. We have sat late at night wondering what we did wrong, and how we could have been better. But we climb on a truck every day. We give up holidays with our families to be with yours. Because you need us. We might bitch and moan about having to be up in the wee hours of the morning. But the truth is, we wouldn't do anything else. -- EMS Me personally. I'm tired of watching the world be so willing to damn people to death based on their job, race, religion, or what the hell ever. If you are willing to think that thought, you don't value human life. Take it from anyone of us. In the last moments of someones life you see them for who they really are. More often than not, they are scared. And honestly, I'm scared when I watch it happen. My heart slams my chest in agony and all I can think is "DO SOMETHING, ANYTHING YOU CAN THINK OF THIS IS WHAT YOU ARE HERE FOR DON'T FAIL!" And very few times have I not failed, sometimes I'm the hero everyone thinks we are. But most of the time the damage someone has decided to do to this human laying in front of me is too great to repair. And no doctor on the planet could save this person. And it kills me to think that this outcome is what someone wanted. It hurts so bad. It hurts so bad because you realize in that moment that human life isn't something to be taken lightly. It carries a weight you could hardly imagine.I'm ashamed of some of you people. But I am also proud of some of you people. The ones who truly care. Please, for me and everyone like me, don't stop caring.I WILL make a post about EMS and what we really do. And I will be trying to get with other EMS personnel to post our craziest work stories. But I just needed to get this off my chest first.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zMr5l
via IFTTT

Bridging the etiologic and prognostic outlooks in individualized assessment of absolute risk of an illness: application in lung cancer

Abstract

Assessment of individual risk of illness is an important activity in preventive medicine. Development of risk-assessment models has heretofore relied predominantly on studies involving follow-up of cohort-type populations, while case–control studies have generally been considered unfit for this purpose. To present a method for individualized assessment of absolute risk of an illness (as illustrated by lung cancer) based on data from a 'non-nested' case–control study. We used data from a case–control study conducted in Montreal, Canada in 1996–2001. Individuals diagnosed with lung cancer (n = 920) and age- and sex-matched lung-cancer-free subjects (n = 1288) completed questionnaires documenting life-time cigarette-smoking history and occupational, medical, and family history. Unweighted and weighted logistic models were fitted. Model overfitting was assessed using bootstrap-based cross-validation and 'shrinkage.' The discriminating ability was assessed by the c-statistic, and the risk-stratifying performance was assessed by examination of the variability in risk estimates over hypothetical risk-profiles. In the logistic models, the logarithm of incidence-density of lung cancer was expressed as a function of age, sex, cigarette-smoking history, history of respiratory conditions and exposure to occupational carcinogens, and family history of lung cancer. The models entailed a minimal degree of overfitting ('shrinkage' factor: 0.97 for both unweighted and weighted models) and moderately high discriminating ability (c-statistic: 0.82 for the unweighted model and 0.66 for the weighted model). The method's risk-stratifying performance was quite high. The presented method allows for individualized assessment of risk of lung cancer and can be used for development of risk-assessment models for other illnesses.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29yKmFj
via IFTTT

Immune Gamma Globulin Therapeutic Indications in Immune Deficiency and Autoimmunity

Abstract

Immune gamma globulin (IgG) has a long history in the treatment of both primary immune deficiency and autoimmune disorders. Disease indications continue to expand and new-generation products increase the versatility of delivery. This review encompasses a historical perspective as well as current and future implications of human immune globulin for the treatment of immune-mediated illness.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29xQTQU
via IFTTT

Submaximal Step Tests to Estimate Maximal Oxygen Uptake in Healthy Adults: Methodological Issues About Validity and Reliability

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29CoIni
via IFTTT

Pokemon Go leads to body in river

A woman playing the game was led to a river, where a body was found. Read the full story .

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29sVS5H
via IFTTT

Initiation of intravitreal aflibercept injection treatment in patients with diabetic macular edema: a review of VIVID-DME and VISTA-DME data

Background: Diabetic macular edema (DME) shows a gradual and sustained functional and morphologic response to anti-vascular endothelial growth factor (VEGF) drugs, but the optimal schedule for initiation of anti-VEGF therapy is not known. This study evaluates the treatment response behavior of DME in the Phase 3 trials of intravitreal aflibercept, with 5 initial intravitreal aflibercept injections (IAI), 2 mg every 4 weeks (2q4), in the upload phase. Methods: This post hoc pooled analysis of the VISTA-DME (NCT01363440) and VIVID-DME (NCT01331681) trials evaluated the change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) during the upload phase, using pooled data from both IAI treatment groups [2q4 and 2 mg every 8 weeks (2q8)]. The mean visit-to-visit change in BCVA and CRT, and the respective rate of gainers and losers was calculated for each successive visit. A secondary analysis compared the visit-to-visit change in BCVA between the 2q4 and 2q8 treatment arms during the upload period and the first year treatment period. Results: The majority of eyes showed a continuing improvement of BCVA after the first IAI. The proportions of eyes gaining BCVA (≥5 letters) at each visit compared with the previous visit during the IAI 2q4 upload phase were 60 (4-weeks), 19 (8-weeks), 16 (12-weeks), 15 (16-weeks), and 14 % (20-weeks). In contrast, the proportions of eyes losing BCVA (≥5 letters) were 3 (4-weeks), 7 (8-weeks), 7 (12-weeks), 9 (16-weeks), and 8 % (20-weeks), respectively. The odds of BCVA (≥5 letters) gain/loss exceeded 1.7 at each visit (range 1.7–20). Overall, the proportion of patients with BCVA gain ≥5 letters at week 20 (compared with baseline) was 76 and 80 % in the 2q4 and 2q8 groups, respectively. The proportions of eyes showing a visit-to-visit decrease in CRT of ≥30 µm during the first 5 IAI were 77 (4-weeks), 27 (8-weeks), 21 (12-weeks), 17 (16-weeks), and 12 % (20-weeks). In the secondary analysis, the BCVA outcomes were similar for the 2q8 and 2q4 treatment arms. Conclusions: The data presented here are consistent with continual functional and anatomic improvement following the fourth and fifth initial 2q4 injections, suggesting that an intensive and sufficiently long upload may be beneficial.Trial registration VIVID-DME: Clinicaltrials.gov: NCT01331681; VISTA-DME: Clinicaltrials.gov: NCT01363440

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2a2SLSI
via IFTTT

Reflections about experiences of compassionate care from award winning undergraduate nurses – What, so what … now what?

Background: From 2007 until 2012 Edinburgh Napier University's School of Nursing Midwifery and Social Care in conjunction with NHS Lothian, collaborated on a programme of action research entitled, the Leadership in Compassionate Care Programme. One strand of this research focused on learning and teaching about compassionate care within the undergraduate curriculum. This debate article focuses on the care issues raised by two award winning nursing students who reflected on the development of their compassionate caring skills during their three year Bachelor of Nursing programme.DiscussionThe reflective accounts debate the following issues related to compassionate care; Personal drivers supporting the provision of compassionate care, Challenging and influencing care practices, Providing relationship centred care and, Living with what can't be achieved. Throughout the debate a model of compassionate care developed from the Leadership in Compassionate Care Programme is used to reflect on key practice issues and provide a framework for practice development. Conclusion: The care issues presented in this paper identify a need to support students in healthcare to; Develop strategies in questioning care practices which do not meet expectations of compassionate care; undertake focussed reflective activities where each student can explore personal drivers, values and perspectives of compassion; actively connect learning in practice with theory in university, enable development in compassionate caring and strategies that support self-compassion; facilitate an understanding and development of emotional intelligence supporting development of resilience.Implications for healthcare staff are to; Collectively seek, hear and respond to feedback about their service; activate caring conversations within the healthcare team; consider how the model of compassionate care presented in this paper, can be used to reflect on practice and provide a framework for development; consider how we maximise the experience of care during brief moments of contact with patients/families; activate leadership that promotes a culture of openness facilitating the development of compassionate care.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zkqvP
via IFTTT

EMS Trauma Coordinator - San Joaquin County

The San Joaquin County Emergency Medical Services Agency is seeking a Registered Nurse with management experience in emergency, intensive care, or trauma fields to serve as the EMS Trauma Coordinator. The successful candidate will have responsibility for the overall planning, administration, coordination, mainte-nance, and evaluation of the County's trauma care system and other critical care systems ...

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29sTa07
via IFTTT

Ethicon’s HARMONIC HD 1000i Shears Cleared by FDA

Ethicon, part of J&J, obtained FDA 510(k) clearance to introduce its HARMONIC HD 1000i surgical shears for use in both open and laparoscopic procedures. It dissects, transects, and seals tissue, so that a separate dissector is not necessary. The instrument is an all-in-one unit, the hand piece and tool integrated together and sounds like it's completely disposable so no additional cleaning and management is needed. Previous similar shears from Ethicon had a separate hand piece that could be used between different procedures.

"HARMONIC HD 1000i is the latest example of our commitment to developing meaningful innovations that can help improve outcomes in critical, complex procedures," in a statement said Grace Chung, Ethicon Vice President, Energy Global Strategic Marketing. "As we move toward the future, HARMONIC HD 1000i will serve as a platform for developing a portfolio of HARMONIC devices focused on trying to meet surgical needs through our in-depth knowledge of tissue and energy sciences to enable surgeons to reach more patients and restore more lives."

Source: Ethicon…

 

 

This post Ethicon's HARMONIC HD 1000i Shears Cleared by FDA appeared first on Medgadget.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29K1wCa
via IFTTT

Electronic Patch Seeded with Patient’s Own Heart Cells for Advanced Monitoring, Treatment of Cardiac Conditions

Over the past few years we've covered a number of electronic patches designed to be biocompatible with the human body to allow for long-term monitoring of various health parameters. We've also seen scaffolds that can host cardiac cells to be used as material to repair heart tissue injured from events such as heart attacks.

At Harvard University a team of researchers has now created a hybrid of these two technologies, resulting in an electronic scaffold within which heart cells can make home. The electronic grid within the device allows for measuring of electric current passing through, and the researchers were able to build 3D electric maps of living animal hearts. Moreover, the same grid can be used to stimulate the heart in complex ways, in its current iteration providing 64 individually controlled electrode points where current can be delivered.

Simultaneous stimulation and monitoring using dense grids seeded with patients' own heart cells may one day allow cardiologists to offer therapy that will make existing pacemakers and other cardiac implants seem genuinely ancient.

Study in Nature Nanotechnology: Three-dimensional mapping and regulation of action potential propagation in nanoelectronics-innervated tissues…

Via: Harvard…

This post Electronic Patch Seeded with Patient's Own Heart Cells for Advanced Monitoring, Treatment of Cardiac Conditions appeared first on Medgadget.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29IBBNV
via IFTTT

Silver Nanolabels-Assisted Ion-Exchange Reaction with CdTe Quantum Dots Mediated Exciton Trapping for Signal-On Photoelectrochemical Immunoassay of Mycotoxins

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b02124

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29zHXLV
via IFTTT

Pokemon Go leads to body in river

A woman playing the game was led to a river, where a body was found. Read the full story .

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/29sVS5H
via IFTTT