Port-site metastasis after explorative laparoscopy for an incidental appendiceal mucinous cystadenocarcinoma detected with FDG PET/CT

A 62-year old female with a history of appendix carcinoma came to our department for an 18 F FDG PET/CT to further characterize a subcutaneous fixed small mass in the right fosse detected at clinical examination. Fourteen months earlier, she had undergone a right hemicolectomy because of an appendiceal mucinous cystadenocarcinoma. Since the diagnosis of appendicitis was presumed before she went into surgery, an explorative laparoscopy was performed. An inflammatory mass with loss of all anatomical references was found; hence the laparoscopy was reverted to a laparotomy

Integrative Review of Managed Entry Agreements: Chances and Limitations.

BACKGROUND AND OBJECTIVE:Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS:An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS:Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS:We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs

R&D in the Belgian Pharmaceutical Sector

The Belgian pharmaceutical sector has been accorded a leading role in the attainment of the R&D investment targets which the EU Member States set themselves as part of the Lisbon strategy. To gain a better insight into that sector’s research activities, the NBB conducted an ad hoc survey in 2005, covering pharmaceutical companies active in Belgium in the field of research, production and distribution of drugs for human use. The analysis of the information obtained from that survey makes up the main body of this working paper. The survey results do not only confirm the importance of the research activities conducted by Belgian establishments, but also indicate the frequent cooperation with other research centres and the crucial importance of expertise as a factor influencing the location of such activities in Belgium. The breakdown of the survey results by kind of establishment on the basis of the type of activities conducted in Belgium reveals further clear differences of emphasis in the nature of the R&D activities pursued in Belgium and divergences in the scale of the resources used. The paper also comprises a number of annexes giving additional information on the sector. More particularly, they deal with added value and employment, the indirect effects and profitability of the pharmaceutical companies, and background information on reference reimbursement of drugs

Personalizing health care: feasibility and future implications

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients

Lipídeos na nutrição de cães e gatos: metabolismo, fontes e uso em dietas práticas e terapêuticas Lipids in dogs and cats nutrition: metabolism, sources and application in practical and therapeutic diets

A partir do desenvolvimento de métodos mais precisos para a avaliação de lipídeos, diversos compostos têm sido descobertos e estudados como forma de enriquecer e melhorar dietas para atender às necessidades dos animais. O triglicerídeo é o principal componente lipídico da dieta e fonte de ácidos graxos que são utilizados para a síntese de outros lipídicos importantes como os fosfolípideos. Os ácidos graxos dos fosfolipídeos possuem papel fundamental na sinalização celular e são substratos das enzimas específicas durante o processo de produção de mediadores de respostas imunológicas. Diversos estudos têm evidenciado a participação de grupos de ácidos graxos das séries ômega 3 e 6 influenciando as respostas inflamatórias em cães e gatos. A deficiência de ácido araquidônico em gatos, por exemplo, pode ser suprida pelo acréscimo de AA pré formado ou pela inclusão de ácido &#947;-linolênico na dieta, que mostrou-se eficiente na sustentação dos níveis de ácido araquidônico exigidos por gatos adultos. Há evidências de que ácidos graxos de cadeia média (AGCM) proporcionam maior incremento calórico durante o processo de oxidação celular, sugerindo sua funcionalidade sobre o controle da obesidade. Outros compostos lipídicos têm sido avaliados quanto a sua participação no processo de controle de ganho de peso. A ausência de um AA nos diacilgliceróis (DAG) pode ser na posição sn 2 ou sn 3 do glicerol gerando DAGs diferentes. O 1,3 DAG quando comparado ao TAG resulta em diferentes efeitos metabólicos que suportam a hipótese de que o acréscimo de DAG na dieta aumenta a oxidação hepática ou intestinal de lipídeos, limitando a deposição de ácidos graxos em triglicerídeos junto ao tecido adiposo.<br>Following the development of more accurate methods for lipid evaluation, various compounds have been discovered and studied as a way to improve and enrich diets to meet the animal requirements. Triglycerides are the major lipid component of diets and source of fatty acids that are used in the synthesis of important compounds as phospholipids. The fatty acids from phospholipids play a fundamental role in cell signaling and are substrates for specific enzymes in the synthesis of immune response mediators. Several studies have shown the involvement of fatty acids, omega 3 and 6 series as influencing the inflammatory responses in dogs and cats. The deficiency of arachidonic acid in cats, for example, can be supplied by preformed arachidonic acid or by addition of &#947;-linolenic acid in the diet, which in turn can sustain the arachidonic acid levels required by adult cats. Evidences suggest that medium chain fatty acids (MCFAs) trigger greater energy expenditure during cellular oxidation, thus indicating their use as an aid for weight control in obesity. Other lipid compounds are under evaluation in their possible effects in the weight gain process in dogs and cats. This absence of one FA in the DAG can be at the sn2 or sn3 position in glycerol, and thus generating different DAGs. The 1,3 DAG when compared to TAG results in different metabolic effects which support the hypothesis that the addition of DAG in diets increases the hepatic or intestinal oxidation of lipids, thus limiting the deposition of fatty acids in adipose tissue triglycerides