Endometrial cancer - reduce to the minimum. A new paradigm for adjuvant treatments?

<p>Abstract</p> <p>Background</p> <p>Up to now, the role of adjuvant radiation therapy and the extent of lymph node dissection for early stage endometrial cancer are controversial. In order to clarify the current position of the given adjuvant treatment options, a systematic review was performed.</p> <p>Materials and methods</p> <p>Both, Pubmed and ISI Web of Knowledge database were searched using the following keywords and MESH headings: "Endometrial cancer", "Endometrial Neoplasms", "Endometrial Neoplasms/radiotherapy", "External beam radiation therapy", "Brachytherapy" and adequate combinations.</p> <p>Conclusion</p> <p>Recent data from randomized trials indicate that external beam radiation therapy - particularly in combination with extended lymph node dissection - or radical lymph node dissection increases toxicity without any improvement of overall survival rates. Thus, reduced surgical aggressiveness and limitation of radiotherapy to vaginal-vault-brachytherapy only is sufficient for most cases of early stage endometrial cancer.</p

Cortisol rapidly increases baroreflex sensitivity of heart rate control, but does not affect cardiac modulation of startle

Cortisol, the final product of human HPA axis activation, rapidly modulates the cortical processing of afferent signals originating from the cardiovascular system. While peripheral effects have been excluded, it remains unclear whether this effect is mediated by cortical or subcortical (e.g. brainstem) CNS mechanisms. Cardiac modulation of startle (CMS) has been proposed as a method to reflect cardio-afferent signals at subcortical (potentially brainstem-) level. Using a single blind, randomized controlled design, the cortisol group (n = 16 volunteers) received 1 mg cortisol intravenously, while the control group (n = 16) received a placebo substance. The CMS procedure involved the assessment of eye blink responses to acoustic startle stimuli elicited at six different latencies to ECG-recorded R-waves (R + 0, 100, 200, 300, 400 and 500 ms). CMS was assessed at four measurement points: baseline, -16 min, +0 min, and +16 min relative to substance application. Baroreflex sensitivity (BRS) of heart rate (HR) control was measured non-invasively based on spontaneous beat-to-beat HR and systolic blood pressure changes. In the cortisol group, salivary cortisol concentration increased after IV cortisol administration, indicating effective distribution of the substance throughout the body. Furthermore, BRS increased in the cortisol group after cortisol infusion. There was no effect of cortisol on the CMS effect, however. These results suggest that low doses of cortisol do not affect baro-afferent signals, but central or efferent components of the arterial baroreflex circuit presumably via rapid, non-genomic mechanisms

Potreba za psihosocijalnom rehabilitacijom oboljelih od raka

In addition to the healing and alleviation of primary somatic cancer symptoms, the comprehensive psycho oncological treatment of cancer patients is an important and fundamental component of oncological rehabilitation in Germany. Rehabilitation treatment encompasses medical, physiotherapeutic, psychological, and creative therapeutic methods, as well as psycho-educational interventions within the framework of an individualized therapy plan. Psycho-oncological interventions within rehabilitation are governed less by individual therapeutic schools of thought, and more by a supportive, patient-centered approach that integrates various psychotherapeutic methods. Adapted methods and techniques from various psychotherapeutic approaches (behavioral therapy, psychoanalytical psychotherapies, systemic family therapy, or hypnotherapy) are currently used in the treatment of cancer patients. A total of N=116 patients of the Paracelsus Clinic am See in Bad Gandersheim were able to be included in the study. In summary, this study shows that about two thirds of the patients admitted to the oncological rehabilitation clinic exhibit middle to high degrees of distress in the areas of anxiety and/or depression. Moreover, it appears to be particularly important to assess not only the mental distress of cancer patients but also their degree of information with regard to psycho-oncological treatment when performing screening for psycho-oncological treatment outside of the rehabilitation clinic setting. Here it is particularly important to accommodate for a differing need for differing forms of treatment (need for counseling, care, or treatment).Sveobuhvatno psiho-onkološko liječenje bolesnika s rakom važan je prilog u liječenju i ublažavanju primarnih somatskih simptoma te temeljna komponenta onkološke rehabilitacije u Saveznoj Republici Njemačkoj. Ova vrsta rehabilitacije obuhvaća medicinske, fizioterapijske, psihološke te kreativno terapijske pristupe, ali i psihoedukacijske intervencije u okviru individualiziranih terapijskih programa. Psiho-onkološki rehabilitacijski postupci manje su određeni kognitivnim psihoterapijskim metodma, a više potpornim, pacijentu usmjerenim pristupima koji obuhvaćaju različite psihoterapijske tehnike. Prilagođene metode i tehnike iz različitih psihoterapijskih pristupa (bihevioralna terapija, psihoanalitička psihoterapija, sistemska obiteljska terapija ili hipnoterapija) predstavljaju suvremeni koncept u liječenju onkoloških bolesnika. Ova studija provedena je na uzorku od 116 pacijenata Paracelsus Clinic am See u Bad Gandersheimu. Rezultati studije pokazali su da dvije trećine pacijenata uključenih u onkološku rehabilitaciju pokazuje srednji do visok stupanj poremećaja u području anksioznosti i/ili depresije. Osim toga, osobito je važno da se u uvjetima definiranja psiho-onkološkog liječenja u izvankliničkim uvjetima ne procjenjuje samo vrsta i stupanj psihičkog poremećaja, već također i razina informiranosti o psiho-onkološkom liječenju. U tom smislu posebno je važno različite oblike liječenja prilagoditi različitim osobnim potrebamabolesnika (npr. potreba za savjetovanjem, njegom, liječenjem)

Potreba za psihosocijalnom rehabilitacijom oboljelih od raka

In addition to the healing and alleviation of primary somatic cancer symptoms, the comprehensive psycho oncological treatment of cancer patients is an important and fundamental component of oncological rehabilitation in Germany. Rehabilitation treatment encompasses medical, physiotherapeutic, psychological, and creative therapeutic methods, as well as psycho-educational interventions within the framework of an individualized therapy plan. Psycho-oncological interventions within rehabilitation are governed less by individual therapeutic schools of thought, and more by a supportive, patient-centered approach that integrates various psychotherapeutic methods. Adapted methods and techniques from various psychotherapeutic approaches (behavioral therapy, psychoanalytical psychotherapies, systemic family therapy, or hypnotherapy) are currently used in the treatment of cancer patients. A total of N=116 patients of the Paracelsus Clinic am See in Bad Gandersheim were able to be included in the study. In summary, this study shows that about two thirds of the patients admitted to the oncological rehabilitation clinic exhibit middle to high degrees of distress in the areas of anxiety and/or depression. Moreover, it appears to be particularly important to assess not only the mental distress of cancer patients but also their degree of information with regard to psycho-oncological treatment when performing screening for psycho-oncological treatment outside of the rehabilitation clinic setting. Here it is particularly important to accommodate for a differing need for differing forms of treatment (need for counseling, care, or treatment).Sveobuhvatno psiho-onkološko liječenje bolesnika s rakom važan je prilog u liječenju i ublažavanju primarnih somatskih simptoma te temeljna komponenta onkološke rehabilitacije u Saveznoj Republici Njemačkoj. Ova vrsta rehabilitacije obuhvaća medicinske, fizioterapijske, psihološke te kreativno terapijske pristupe, ali i psihoedukacijske intervencije u okviru individualiziranih terapijskih programa. Psiho-onkološki rehabilitacijski postupci manje su određeni kognitivnim psihoterapijskim metodma, a više potpornim, pacijentu usmjerenim pristupima koji obuhvaćaju različite psihoterapijske tehnike. Prilagođene metode i tehnike iz različitih psihoterapijskih pristupa (bihevioralna terapija, psihoanalitička psihoterapija, sistemska obiteljska terapija ili hipnoterapija) predstavljaju suvremeni koncept u liječenju onkoloških bolesnika. Ova studija provedena je na uzorku od 116 pacijenata Paracelsus Clinic am See u Bad Gandersheimu. Rezultati studije pokazali su da dvije trećine pacijenata uključenih u onkološku rehabilitaciju pokazuje srednji do visok stupanj poremećaja u području anksioznosti i/ili depresije. Osim toga, osobito je važno da se u uvjetima definiranja psiho-onkološkog liječenja u izvankliničkim uvjetima ne procjenjuje samo vrsta i stupanj psihičkog poremećaja, već također i razina informiranosti o psiho-onkološkom liječenju. U tom smislu posebno je važno različite oblike liječenja prilagoditi različitim osobnim potrebamabolesnika (npr. potreba za savjetovanjem, njegom, liječenjem)

Técnicas de dramatización en la enseñanza del inglés como lengua extranjera en el aula de Educación Infantil

El objetivo principal de este trabajo es amparar la validez de la aplicación de técnicas de dramatización para la enseñanza del inglés como lengua extranjera en el aula de Educación Infantil. Para ello en primer lugar se expone el marco teórico en el que se enmarca el uso de técnicas de dramatización en la educación, para, después, explicar más detalladamente el uso de la dramatización en la enseñanza de una lengua extranjera profundizando en sus aplicaciones, sus ventajas y cómo aparece recogido en la actual legislación educativa. Después, se propone una posible secuencia didáctica basada en el uso de dichas técnicas cuya primera sesión ha sido aplicada en un aula de infantil del CEIP El Parque (Huesca) y posteriormente evaluada con la intención de exponer un caso real cuyos resultados sirvan de utilidad para maestros de Educación Infantil. Por último, se exponen las conclusiones obtenidas a partir de la realización de este trabajo. Con todo esto pretendo mostrar la amplitud de posibilidades y aplicaciones educativas que ofrece la dramatización, en concreto, en la enseñanza del inglés, con la intención de servir de inspiración para futuros docentes y mostrar una posible manera de enriquecer la actual metodología utilizada en las aulas de inglés

Activation-Induced Cytidine Deaminase (AID)-Associated Multigene Signature to Assess Impact of AID in Etiology of Diseases with Inflammatory Component

Activation-induced cytidine deaminase (AID) is expressed in B cells within germinal centers and is critically involved in class switch recombination and somatic hypermutation of immunoglobulin loci. Functionally active AID can additionally be detected within ectopic follicular structures developed at sites of chronic inflammation. Furthermore, AID may target non-Ig genes in B- and non-B-cell background. Therefore, AID-associated effects are of increasing interest in disease areas such as allergy, inflammation, autoimmunity, and cancer

Study protocol for a prospective, non-controlled, multicentre clinical study to evaluate the diagnostic accuracy of a stepwise two-photon excited melanin fluorescence in pigmented lesions suspicious for melanoma (FLIMMA study)

Introduction: Non-invasive, nanosecond, stepwise two-photon laser excitation of skin tissue was shown to induce melanin fluorescence spectra that allow for the differentiation of melanocytic nevi from cutaneous melanoma. Methods and analysis: This prospective, non-controlled, multicentre clinical study is performed to evaluate the diagnostic performance of the stepwise two-photon excited melanin fluorescence in the detection of cutaneous melanoma. The comparator will be the histopathological diagnosis. A total of 620 pigmented skin lesions suspicious for melanoma and intended for excision will be enrolled. Ethics and dissemination: Ethics approval was provided by the local ethics committees of the medical faculties of the University of Tuebingen, Heidelberg and Berlin. Study registration: The FLIMMA study NCT02425475

Application of agronomic practice improves phytoextraction on a multipolluted site

In the context of a joint research project in collaboration with the municipal water works of Leipzig, BioPlanta optimizes the phytoremediation process. This Phytotechnology has been applied since 1996 to a former sewage sludge dewatering plant in Schladitz near Leipzig (Fig 1). At the time of closing in 1990 about 300,000 m3 of heavy metal‐ and hydrocarbon‐contaminated sludge were stored on this site. It is the biggest phytoremediation project of this kind in Europe. An extensive monitoring and analysis program was established to evaluate the progress of the remediation (ending in 2012). Up to now the contamination of the site could be considerably decreased. The removal of heavy metals sums up to several kilograms with an increasing tendency over the last years (Fig 2). The aim of ongoing research activities is to set up improved conditions for an even more efficient extraction of heavy metal ions from contaminated soil and sediments. Optimizing this process should reduce the remediation period by up to two thirds. The technology is to be implemented not only in the Leipzig region but also in future remediation projects. Agronominių priemonių taikymas, gerinant fitoekstrakciją įvairiais teršalais užterštose vietose Santrauka Vykdydama bendrą tiriamąjį projektą atliekant vandens tyrimus Leipcige BioPlanta optimizuoja fitoatkūrimo procesą. Ši fitotechnologija taikoma nuo 1996 metų ankstesnei iš nuotekų dumblo vandenį šalinančiai įrangai Šladice netoli Leipcigo (1 pav.). Uždarant įrangą 1990 metais apie 300 000 m3 dumblo, užteršto sunkiaisiais metalais ir angliavandeniliais, buvo sukaupta šiame sklype. Tai didžiausias tokio pobūdžio fitoatkūrimo projektas Europoje. Buvo sukurta plati monitoringo ir analizės programa siekiant įvertinti atkūrimo eigą (iki 2012 metų). Sklypo tarša galėjo labai sumažėti. Sunkiųjų metalų pašalinimas siekia daugiau kaip kelis kilogramus su didėjimo tendencija pastaraisiais metais (2 pav.). Tyrimo tikslas – sudaryti geresnes sąlygas dar efektyvesnei sunkiųjų metalų jonų ekstrakcijai iš užteršto dirvožemio ir nuosėdų. Optimizuojant šį procesą atkūrimo laikotarpis turėtų sutrumpėti iki dviejų trečdalių. Ši technologija turi būti įgyvendinama ateityje vykdant atkūrimo projektus. Reikšminiai žodžiai: fitoatkūrimas, metalų biogalimybės, augalų parinkimas, pasėlių priežiūra, augalų biomasė. Применение агрономических средств для улучшения фитоэкстракции в местах, загрязненных несколькими загрязнителями Резюме В результате сотрудничества с самоуправлением Лейпцига в создании общего проекта исследований по вопросам водных работ «БиоПланта» оптимизирует процесс фиторемедиации. Эта фитотехнология применялась в Шладице около Лейпцига с 1996 г. в оборудовании по удалению воды из ила сточных вод (Рис. 1). После 1990 г., когда упомянутое оборудование перестало применяться, на участке было собрано 300 000 м3 ила, загрязненного тяжелыми металлами и углеводородом. Это самый крупный проект фиторемедиации такого типа в Европе. Для оценки эффективности процесса восстановления до 2012 г. будет создана широкая программа мониторинга и анализа. Загрязнение этого места должно значительно уменьшиться. Загрязнение тяжелыми металлами составляет несколько килограммов, а в последние годы имеет тенденцию к увеличению (Рис. 2). Целью проводящихся исследований было создание лучших условий для более эффективной экстракции ионов тяжелых металлов из загрязненной почвы и осадков. В результате оптимизации этого процесса период восстановления должен уменьшиться. Названная технология должна быть внедрена в Лейпцигском регионе, а также внедряться в будущем при осуществлении восстановительных проектов. Ключевые слова: фиторемедиация, биовозможности металлов, подбор растений, уход за посевами, биомасса растений. First Published Online: 14 Oct 201

Increased plasma vaspin concentration in patients with sepsis: an exploratory examination

Introduction: Vaspin (visceral adipose tissue-derived serpin) was first described as an insulin-sensitizing adipose tissue hormone. Recently its anti-inflammatory function has been demonstrated. Since no appropriate data is available yet, we sought to investigate the plasma concentrations of vaspin in sepsis. Materials and methods: 57 patients in intensive care, fulfilling the ACCP/SCCM criteria for sepsis, were prospectively included in our exploratory study. The control group consisted of 48 critically ill patients, receiving intensive care after trauma or major surgery. Patients were matched by age, sex, weight and existence of diabetes before statistical analysis. Blood samples were collected on the day of diagnosis. Vaspin plasma concentrations were measured using a commercially available enzyme-linked immunosorbent assay. Results: Vaspin concentrations were significantly higher in septic patients compared to the control group (0.3 (0.1-0.4) ng/mL vs. 0.1 (0.0-0.3) ng/mL, respectively; P < 0.001). Vaspin concentration showed weak positive correlation with concentration of C-reactive protein (CRP) (r = 0.31, P = 0.002) as well as with SAPS II (r = 0.34, P = 0.002) and maximum of SOFA (r = 0.39, P < 0.001) scoring systems, as tested for the overall study population. Conclusion: In the sepsis group, vaspin plasma concentration was about three-fold as high as in the median surgical control group. We demonstrated a weak positive correlation between vaspin and CRP concentration, as well as with two scoring systems commonly used in intensive care settings. Although there seems to be some connection between vaspin and inflammation, its role in human sepsis needs to be evaluated further

Increased plasma zonulin in patients with sepsis

Introduction: Zonulin is a eukaryotic protein structurally similar to Vibrio cholerae’s zonula occludens toxin. It plays an important role in the opening of small intestine tight junctions. The loss of gut wall integrity during sepsis might be pivotal and has been described in various experimental as well as human studies. Increased levels of zonulin could be demonstrated in diseases associated with increased intestinal inflammation, such as celiac disease and type 1 diabetes. We therefore investigated the role of plasma levels of zonulin in patients with sepsis as a non-invasive marker of gut wall integrity. Materials and methods: Plasma level of zonulin was measured in 25 patients with sepsis, severe sepsis or septic shock according to ACCP/SCCM criteria at the first day of diagnosed sepsis. 18 non-septic post-surgical ICU-patients and 20 healthy volunteers served as control. Plasma levels were determined by using commercially available ELISA kit. Data are given as median and interquartile range (IQR). Results: Significantly higher plasma concentration of zonulin were found in the sepsis group: 6.61 ng/mL (IQR 3.51-9.46), as compared to the to the post-surgical control group: 3.40 ng/mL (IQR 2.14-5.70) (P = 0.025), as well as to the healthy group: 3.55 ng/mL (IQR 3.14-4.14) (P = 0.008). Conclusion: We were able demonstrate elevated levels of plasma zonulin, a potential marker of intestinal permeability in septic patients. Increased zonulin may serve as an additional mechanism for the observed increased intestinal permeability during sepsis and SIRS