Locoregional therapies in cholangiocarcinoma

Cholangiocarcinoma is a rare and aggressive malignancy of the biliary tract. Complete surgical resection can be curative, but the majority of patients are diagnosed with advanced disease and usually die within a year of diagnosis. Most deaths are attributable to local disease progression rather than distant metastases, supporting the use of locoregional therapies. There is evidence that locoregional therapies can provide local tumor control resulting in increased survival while avoiding some of the side effects of systemic treatments, increasing potential treatment options for patients who may be unsuitable for systemic palliative treatments. This review considers the evidence for locoregional therapies in cholangiocarcinoma, which can be classified into endoscopic, vascular, percutaneous and radiation oncological therapies. Current guidelines do not recommend the routine use of locoregional therapies due to a lack of prospective data, but the results of ongoing trials are likely to increase the evidence base and impact on clinical practice

The effect of osteoarthritis definition on prevalence and incidence estimates: A systematic review

Objective: To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. Method: A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified. Results: Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn't allow us to make any comparison according to joint site or OA definition. Conclusions: Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions. © 2011 Osteoarthritis Research Society International

Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis

Aim: To evaluate the potential role of age, sex, body mass index (BMI), radiographic features and pain in knee osteoarthritis (OA) case ascertainment. Methods: A cross‐sectional study was performed using information from the EPIPorto cohort; social, demographic, behavioral and clinical data was obtained. Pain was assessed using a pain frequency score (regarding ever having knee pain, pain in the last year, in the last 6 months and in the last month). Knee radiographs were classified using the Kellgren–Lawrence scale (0–4). Path analysis was used to assess the plausibility of the causal assumptions and a classification tree to identify characteristics that could improve the identification of patients with radiographic OA. Results: Higher age and higher BMI were associated with higher radiographic score, but sex had no statistical association. Females, higher age, higher BMI and higher radiographic score were statistically associated with higher pain scores. For both genders, the classification tree estimated age as the first variable to identify individuals with knee radiographic features. In females older than 56 years, pain frequency score is the second discriminator characteristic, followed by age (> 65 years) and (BMI > 30 kg/m2). Higher pain frequency and BMI > 29 kg/m2 were relevant for identifying OA in men with ages between 43.5 and 55.5 years. Conclusions: Age, BMI and pain frequency are independently associated with radiographic OA and the use of information on these characteristics can improve the identification of patients with knee OA. Beyond age, pain complaints are particularly relevant but the level of pain is different by sex

The Effect of Transposable Element Insertions on Gene Expression Evolution in Rodents

Background:Many genomes contain a substantial number of transposable elements (TEs), a few of which are known to be involved in regulating gene expression. However, recent observations suggest that TEs may have played a very important role in the evolution of gene expression because many conserved non-genic sequences, some of which are know to be involved in gene regulation, resemble TEs. Results:Here we investigate whether new TE insertions affect gene expression profiles by testing whether gene expression divergence between mouse and rat is correlated to the numbers of new transposable elements inserted near genes. We show that expression divergence is significantly correlated to the number of new LTR and SINE elements, but not to the numbers of LINEs. We also show that expression divergence is not significantly correlated to the numbers of ancestral TEs in most cases, which suggests that the correlations between expression divergence and the numbers of new TEs are causal in nature. We quantify the effect and estimate that TE insertion has accounted for ~20% (95% confidence interval: 12% to 26%) of all expression profile divergence in rodents. Conclusions:We conclude that TE insertions may have had a major impact on the evolution of gene expression levels in rodents

The economic impact of water supply disruption from the Selangor River, Malaysia

Abstract The insidious economic impact of water disruption has received less attention compared to palpable climate disasters but climate change and water security concerns call for investigation on cost consequences of property values and business losses in an already fragile water supply demand balance in many developing countries The economic impact of frequent water supply disruptions from the Selangor River in Malaysia due to technical issues water pollution and climate related problems was estimated using the stock flow measure to assess property at risk and survey to estimate business loss The findings revealed that commercial residential and industrial property valued at RM459 041 million in 2020 in the State of Selangor and parts of Kuala Lumpur were at risk due to frequent water supply disruptions A survey of small and medium enterprises from the manufacturing construction and services sectors revealed that 46 of the respondents were affected with losses amounting to RM2 053 million The total economic impact of water supply disruption in 2020 combining both property value at risk and business loss amounted to RM461 094 million which accounted for 34 of Malaysia s GDP A number of recommendations are made to prevent the widespread occurrence of water disruption

[telephone Monitoring Service For Pregnant Women And Impact On Prevalence Of Prematurity And Associated Risk Factors In Piracicaba, São Paulo State, Brazil].

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Challenges in monitoring and managing engineered slopes in a changing climate

Geotechnical asset owners need to know which parts of their asset network are vulnerable to climate change induced failure in order to optimise future investment. Protecting these vulnerable slopes requires monitoring systems capable of identifying and alerting to asset operators changes in the internal conditions that precede failure. Current monitoring systems are heavily reliant on point sensors which can be difficult to interpret across slope scale. This paper presents challenges to producing such a system and research being carried out to address some of these using electrical resistance tomography (ERT). Experimental results show that whilst it is possible to measure soil water content indirectly via resistivity the relationship between resistivity and water content will change over time for a given slope. If geotechnical parameters such as pore water pressure are to be estimated using this method then ERT systems will require integrating with more conventional geotechnical instrumentation to ensure correct representative information is provided. The paper also presents examples of how such data can be processed and communicated to asset owners for the purposes of asset management

Decreasing Mortality in Severe Sepsis and Septic Shock Patients by Implementing a Sepsis Bundle in a Hospital Setting

Background The Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis (SS) and septic shock (SSh) have been recommended to reduce morbidity and mortality. Materials and Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize SS and SSh shock patients\u27 clinical outcomes were performed by applying sepsis bundles (6- and 24-hour) in May 2006. We compared bundle compliance and patient outcomes before (July 2005-April 2006) and after (May 2006-December 2009) implementation of the interventions. Results A total of 564 SS and SSh patients were identified. Prior to the intervention, compliance with the 6 hour-sepsis resuscitation bundle was only 6%. After the intervention, compliance was as follows: 8.2% from May to December 2006, 9.3% in 2007, 21.1% in 2008 and 13.7% in 2009. For the 24 hour-management bundle, baseline compliance was 15.0%. After the intervention, compliance was 15.1% from May to December 2006, 21.4% in 2007, 27.8% in 2008 and 44.4% in 2009. The in-hospital mortality was 54.0% from July 2005 to April 2006, 41.1% from May to December 2006, 39.3% in 2007, 41.4% in 2008 and 16.2% in 2009. Conclusion These results suggest reducing SS and SSh patient mortality is a complex process that involves multiple performance measures and interventions

Rationale, design, and analysis of combined Brazilian household budget survey and food intake individual data

<p>Abstract</p> <p>Background</p> <p>Data on food intake at the individual level and its statistical distribution in population groups defined by age, gender, or geographic areas are important in planning public health and nutrition programs. However, individual-based surveys in representative population samples are expensive to perform.</p> <p>Methods/Design</p> <p>In Brazil, an individual based survey is under consideration to be conducted alongside the household budget survey (HBS), which will be carried out in 2008–2009. This paper presents the methodological framework of dietary data collection and indicates the directions to combining both sources of data.</p> <p>The 2008–2009 Brazilian HBS sample will include 60,000 households. Of the selected HBS households, 30% will be randomly sampled to gather data on individual food intake. Therefore, individual dietary intake data is expected to be gathered for 70,000 individuals. Data collection procedures will comprise: completion of a diary with information regarding food purchases during a seven-day period; registration of all items consumed during two non-consecutive days for all 10 year-old or older members of the household. The sample will be large enough to capture the variation between individuals, and the two records will assure the estimation of the variation within individuals for food groups, energy and nutrients. Data on individual dietary intake and food family budget will be stratified by the five regions of the country and by rural or urban. A pilot study has been conducted in two states, and it indicated that combining individual and budgetary data in a survey is feasible.</p> <p>Discussion</p> <p>This kind of study will allow us to estimate correlations between individual intake and household purchases, overcoming the limitations of individual dietary surveys, and enhancing the HBS with information on eating out and intra-familiar distribution of food.</p