Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

: The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives

Lipid profile and growth of black soldier flies (Hermetia illucens, Stratiomyidae) reared on by‐products from different food chains

BACKGROUND The total amount of bio‐waste produced annually in the EU by the food and beverage chains is estimated at 37 Mtons. The possibility to use insects for the valorization of by‐products from these value chains may represent a sustainable solution. This study aims at investigating the by‐products obtained from different food chains for the rearing of black soldier fly prepupae to evaluate lipid content and profile and outline its possible applications. The substrates used in this experiment were: (i) industrial by‐products (brewery spent grains, cow's milk whey, grape stalks, and tomato peels and seeds) and (ii) by‐products from retailers (bread dough, fish scraps, and spent coffee ground). Fat extracted from prepupae using an adjusted Folch method was utilized for total lipid content and fatty acids profile. RESULTS Best larval performances were obtained from beer (0.22 gweight per prepupa), tomato (0.19 gweight per prepupa), and cheese (0.14 gweight per prepupa) food‐chain by‐products. The extremely different composition of the substrate was reflected in the differentiated lipid profile of black soldier fly prepupae and in a range of ratios between unsaturated and saturated fatty acids comprised from 0.37 for cow's milk way to 1.34 for tomato peels and seeds. CONCLUSION The high content and type of lipids, together with the proteins, and chitin extracted from prepupae are high‐value bio‐based products that could be used in the feed/food industry or for the development of innovative biomaterials, such as biodiesel. These results suggest that food chain by‐products are the best candidate for insect‐bioconversion purposes

Detection of human neurotropic JCPyV DNA sequence in pediatric anaplastic xanthoastrocytoma

Due to its peculiar histopathological findings, pleomorphic xanthoastrocytoma (PXA), a rare cerebral tumor of young adults with a slow growth and a good prognosis, resembles to the lytic phase of progressive multifocal leukoencephalopathy, a fatal neurodegenerative disease caused by JC polyomavirus (JCPyV). Therefore, the presence of JCPyV DNA was examined in an 11-year-old child with xanthoastrocytoma, WHO grade 3, by quantitative PCR (qPCR) and nested PCR (nPCR) using primers amplifying sequences encoding the N- and C-terminal region of large T antigen (LTAg), the non-coding control region (NCCR), and viral protein 1 (VP1) DNA. The expression of transcripts from LTAg and VP1 genes was also evaluated. In addition, viral microRNAs’ (miRNAs) expression was investigated. Cellular p53 was also searched at both DNA and RNA level. qPCR revealed the presence of JCPyV DNA with a mean value of 6.0× 104 gEq/mL. nPCR gave a positive result for the 5ʹ region of the LTAg gene and the NCCR, whereas 3ʹ end LTAg and VP1 DNA sequences were not amplifiable. Only LTAg transcripts of 5ʹ end were found whereas VP1 gene transcript was undetectable. Although in most cases, either Mad-1 or Mad-4 NCCRs have been identified in association with JCPyV-positive human brain neoplasms, the archetype NCCR structure was observed in the patient’s sample. Neither viral miRNA miR-J1-5p nor p53 DNA and RNA were detected. Although the expression of LTAg supports the possible role of JCPyV in PXA, further studies are warranted to better understand whether the genesis of xanthoastrocytoma could depend on the transformation capacity of LTAg by Rb sequestration

Water in the Green Economy: Capacity Development Aspects

This book discusses needs related to capacity development for water resources management, including water supply and sanitation, in the context of the green economy. It showcases theoretical and practical approaches with proven success. Most contributions come from members and partners within the interagency mechanism, UN-Water. The 11 case studies in this book range from innovative design and delivery of capacity development programs related to water in the green economy, market mechanisms, and quality control procedures supporting capacity development success towards the practical implementation of programs to enhance individual and institutional capacity

Diagnosis of anal human papillomavirus infection: polymerase chain reaction or cytology?

Summary Objectives To investigate the relationship between human immunodeficiency virus (HIV)-positive and HIV-negative patients engaging in promiscuous behaviors and anal human papillomavirus (HPV) infection diagnosed by polymerase chain reaction (PCR) and cytology. Methods Fifty-six HIV-positive patients and 49 HIV-negative patients who engaged in sexually promiscuous behavior were enrolled in the study. We performed cytological exams using the Pap smear and PCR for HPV-DNA detection, with identification of oncogenic strains. The 2001 Bethesda System terminology was used for the cytological exams. We also evaluated the immunologic status of the HIV-infected patients. Results PCR positivity for HPV-DNA was higher in the group of HIV-positive patients than in the group of HIV-negative patients with a statistically significant difference. In contrast we did not find any statistically significant difference by cytological exam. Oncogenic strains were equally distributed in the two groups. Conclusions Our results indicate the importance of the cytological exam for anal HPV screening in the population at high risk of sexually transmitted disease and that HPV-DNA PCR can be used only as adjunct test

Echography in brain imaging in intensive care unit: State of the art

Transcranial sonography (TCS) is an ultrasound-based imaging technique, which allows the identification of several structures within the brain parenchyma. In the past it has been applied for bedside assessment of different intracranial pathologies in children. Presently, TCS is also used on adult patients to diagnose intracranial space occupying lesions of various origins, intracranial hemorrhage, hydrocephalus, midline shift and neurodegenerative movement disorders, in both acute and chronic clinical settings. In comparison with conventional neuroimaging methods (such as computed tomography or magnetic resonance), TCS has the advantages of low costs, short investigation times, repeatability, and bedside availability. These noninvasive characteristics, together with the possibility of offering a continuous patient neuro-monitoring system, determine its applicability in the monitoring of multiple emergency and non-emergency settings. Currently, TCS is a still underestimated imaging modality that requires a wider diffusion and a qualified training process. In this review we focused on the main indications of TCS for the assessment of acute neurologic disorders in intensive care unit. KEYWORDS: Brain imaging; Brain sonography; Cerebral hemorrhage; Cerebral sonography; Hydrocephalus; Transcranial sonography; Ultrasounds PMID: 25276307 PMCID: PMC4176781 DOI: 10.4329/wjr.v6.i9.63

Estimation of admixture in two Venezuelan populations using Ancestry Informative Markers and haplogroups of mitochondrial DNA

Los marcadores informativos de ancestralidad (AIM) autosómicos y los del ADN mitocondrial (ADNmt) son muy útiles para identificar el origen y los patrones de migración de las poblaciones. En este trabajo se estimó el mestizaje a partir de siete AIM en 188 individuos venezolanos, 84 del estado Guárico y 104 de la región centro occidental de Venezuela (RCO), se estimó la ancestralidad mitocondrial en el estado Guárico y se compararon ambas poblaciones según su origen y desarrollo histórico. Este estudio representa la primera aproximación a la composición genética de Guárico y es el primer reporte para Venezuela utilizando marcadores tipo AIM. Los resultados revelaron que los aportes amerindio y europeo predominan en estas poblaciones, pero el amerindio es mayor en Guárico (50,57%) que en RCO (44,92%), y el europeo lo es en RCO (38,46% vs. 33,72%). El origen del ADNmt en Guárico es de predominio amerindio (80%), tendencia similar a lo reportado para RCO (75%). El aporte amerindio en Guárico es el más alto reportado para Venezuela. Se concluye que las diferencias encontradas entre ambas muestras podrían deberse a la colonización más temprana de la RCO y a su desarrollo industrial moderado durante el siglo XIX. Así mismo, planteamos que los AIM aquí utilizados lograron una buena discriminación del aporte de los tres grupos ancestrales principales y que su uso simultáneo con polimorfismos de origen uniparental permite obtener, en forma económica, una mejor aproximación genética para explicar la dinámica del proceso de mestizaje que dio origen a la población venezolana actualAncestral informative markers (AIMs) and mitochondrial DNA (mtDNA) are highly useful to understand the origin of populations and their migration patterns. In this work, admixture was estimated using seven AIMs in 188 Venezuelan individuals, 84 belonging to the state of Guárico and 104 belonging to the central western region of Venezuela (RCO). Mitochondrial ancestry of Guárico was also determined, and both populations were compared according to their origin and historical development. This study constitutes the first approximation to the genetic composition of Guárico, and it is the first report for Venezuela using AIMs. The results revealed that Amerindian and European contributions predominate in these populations, but Amerindian is higher in Guárico (50.57%) than in RCO (44.92%), while European is higher in RCO (38.46% vs. 33.72%). In Guárico mtDNA is predominantly Amerindian (80%), as previously reported for RCO (75%). The Amerindian contribution in Guárico is the highest reported for Venezuela. We conclude that the differences found between both samples could be due to an earlier colonization of RCO and to its moderate industrial development during the nineteenth century. We also conclude that the AIMs used here made a good differentiation of the contribution of the three main ancestral groups at a relatively low cost, so that their use, together with polymorphisms of uniparental origin, allows a better genetic approach to explaining the dynamics of the mixing process giving rise to the current Venezuelan population.Asociación de Antropología Biológica de la República Argentin

Rafoxanide sensitizes colorectal cancer cells to TRAIL-mediated apoptosis

Colorectal cancer (CRC) remains a leading causes of cancer-related death in the world, mainly due to the lack of effective treatment of advanced disease. TNF-related apoptosis-inducing ligand (TRAIL)-driven cell death, a crucial event in the control of tumor growth, selectively targets malignant rather than non-transformed cells. However, the fact that cancer cells, including CRC cells, are either intrinsically resistant or acquire resistance to TRAIL, represents a major hurdle to the use of TRAIL-based strategies in the clinic. Agents able to overcome CRC cell resistance to TRAIL have thus great therapeutic potential and many researchers are making efforts to identify TRAIL sensitizers. The anthelmintic drug rafoxanide has recently emerged as a potent anti-tumor molecule for different cancer types and we recently reported that rafoxanide restrained the proliferation of CRC cells, but not of normal colonic epithelial cells, both in vitro and in a preclinical model mimicking sporadic CRC. As these findings were linked with the induction of endoplasmic reticulum stress, a phenomenon involved in the regulation of various components of the TRAIL-driven apoptotic pathway, we sought to determine whether rafoxanide could restore the sensitivity of CRC cells to TRAIL. Our data show that rafoxanide acts as a selective TRAIL sensitizer in vitro and in a syngeneic experimental model of CRC, by decreasing the levels of c-FLIP and survivin, two key molecules conferring TRAIL resistance. Collectively, our data suggest that rafoxanide could potentially be deployed as an anti-cancer drug in the combinatorial approaches aimed at overcoming CRC cell resistance to TRAIL-based therapies