Significance of plasma chromogranin A determination in neuroendocrine tumour (NET) diagnosis.

The secretory nature of NETs implies the determination of the CgA concentration as a standard marker. The concentration of CgA in plasma correlates with the degree of histopathological differentiation, tumor stage, and is an essential prerequisite for therapy. A retrospective analysis of the results of the plasma CgA concentrations in relation to histopathological and clinical findings (type of NET according to the WHO classification, severity of disease based on the presence of metastases and clinical symptoms) as well as somatostatin receptor scintigraphy was performed in 41 patients with NET. The patients were treated in The Regional Oncology of Lublin from February 2005 to May 2008. Data from the literature and results of this study suggest the use of CgA in the diagnosis and prognosis of NET. Plasma CgA concentration analysed together with histopathological assessment of tumor and the clinical picture is a useful marker in the diagnosis of neuroendocrine tumours. High plasma CgA concentrations may indicate the presence of highly-differentiated NET (WDNEC), and also may indicate the presence of tumor metastasis. The highest CgA concentrations were observed in patients with neuroendocrine tumors associated with carcinoid symptoms and the presence of metastases to the liver

Simulation techniques in the anatomy curriculum: review of literature

Modern medical education faces a problem of combining the latest technology, procedures and information with classic teaching methods. Simulation is a technique, which replaces or amplifies doctor–patient experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner. The basic course of anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum. The PubMed database was searched using specific key words. Finally 72 articles were accepted and were divided into 3 basic categories of teaching methods: Category 1 — cadaveric dissection, Category 2 — simulator based education and Category 3 — other. A state of the art anatomical curriculum offers numerous possibilities and solutions including the oldest like cadaveric dissection and newest like simulators. Different simulation techniques are used with different intensity; however cadaveric dissection is still the most popular method. The second most frequent method is simulation-based training, in which North America is the leading country. The identification of anatomical structures during virtual surgical procedures or laparoscopic robotic procedures can be integrated into the traditional anatomy course. New technologies are supportive and beneficial in anatomy teaching however each excitement of new technologies sometimes should be tempered and evaluated for its usefulness in making the learning process constructive for students and their future practice

Trastuzumab emtansine (T-DM1) in patients with HER2-positive metastatic breast cancer and brain metastases: exploratory final analysis of cohort 1 from KAMILLA, a single-arm phase IIIb clinical trial

Background: Patients with brain metastases (BM) from human epidermal growth factor receptor 2 (HER2)-positive breast cancer represent a difficult-to-treat population. Trastuzumab emtansine (T-DM1) has shown potential activity in this subset of patients in small clinical series. Patients and methods: KAMILLA is an ongoing, phase IIIb study of T-DM1 in patients with HER2-positive locally advanced/metastatic breast cancer with prior HER2-targeted therapy and chemotherapy. Patients received T-DM1 3.6 mg/kg every 3 weeks (intravenously) until unacceptable toxicity, withdrawal of consent, or disease progression. Tumor response and clinical outcomes in patients with baseline BM were evaluated in this post hoc, exploratory analysis. The main outcome measures were best overall response rate (complete response + partial response) and clinical benefit rate (complete response + partial response + stable disease lasting =6 months) by RECIST v1.1 criteria, progression-free survival, overall survival, and safety. Results: Of 2002 treated patients, 398 had baseline BM. In 126 patients with measurable BM, the best overall response rate and clinical benefit rate were 21.4% [95% confidence interval (CI) 14.6–29.6] and 42.9% (95% CI 34.1–52.0), respectively. A reduction in the sum of the major diameters of BM =30% occurred in 42.9% (95% CI 34.1–52.0), including 49.3% (95% CI 36.9–61.8) of 67 patients without prior radiotherapy to BM. In the 398 patients with baseline BM, median progression-free survival and overall survival were 5.5 (95% CI 5.3–5.6) months and 18.9 (95% CI 17.1–21.3) months, respectively. The adverse event profile was broadly similar in patients with and without baseline BM, although nervous system adverse events were more common in patients with [208 (52.3%)] versus without [701 (43.7%)] baseline BM. Conclusion: This exploratory analysis of patients with HER2-positive metastatic breast cancer and BM enrolled in a prospective clinical trial shows that T-DM1 is active and well-tolerated in this population. T-DM1 should be explored further in this setting

Prospective, Single-Arm, Longitudinal Study of Biomarkers in Real-World Patients with Severe Asthma

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Cardiovascular MRI evidence of reduced systolic function and reduced LV mass in rheumatoid arthritis: impact of disease phenotype

The accelerated risk of cardiovascular disease (CVD) in Rheumatoid Arthritis (RA) requires further study of the underlying pathophysiology and determination of the at-risk RA phenotype. Our objectives were to describe the cardiac structure and function and arterial stiffness, and association with disease phenotype in patients with established) RA, in comparison to healthy controls, as measured by cardiovascular magnetic resonance imaging (CMR). 76 patients with established RA and no history of CVD/diabetes mellitus were assessed for RA and cardiovascular profile and underwent a non-contrast 3T-CMR, and compared to 26 healthy controls. A univariable analysis and multivariable linear regression model determined associations between baseline variables and CMR-measures. Ten-year cardiovascular risk scores were increased in RA compared with controls. Adjusting for age, sex and traditional cardiovascular risk factors, patients with RA had reduced left ventricular ejection fraction (mean difference − 2.86% (− 5.17, − 0.55) p = 0.016), reduced absolute values of mid systolic strain rate (p < 0.001) and lower late/active diastolic strain rate (p < 0.001) compared to controls. There was evidence of reduced LV mass index (LVMI) (− 4.56 g/m2 (− 8.92, − 0.20), p = 0.041). CMR-measures predominantly associated with traditional cardiovascular risk factors; male sex and systolic blood pressure independently with increasing LVMI. Patients with established RA and no history of CVD have evidence of reduced LV systolic function and LVMI after adjustment for traditional cardiovascular risk factors; the latter suggesting cardiac pathology other than atherosclerosis in RA. Traditional cardiovascular risk factors, rather than RA disease phenotype, appear to be key determinants of subclinical CVD in RA potentially warranting more effective cardiovascular risk reduction programs

Клинико-иммунологическая характеристика острых респираторных заболеваний у детей в возрасте до 5 лет ассоциированные с герпес инфекцией

Department of Pediatrics, Municipal Clinical Hospital of Children No 1, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe research group was 47 children under 5 years old with severe respiratory diseases, associated with Herpes-infection. Diagnosis of Herpes-infection was confirmed by PCR and IFM. Immunological disorders were observed in 2/3 cases (decreasing level of CD4, CD8, CD20 and serological fraction IgA and IgG). The presence of HSV and/or CMV in parents was confirmed (PCR – 79%, ELISA – 11%). Viral association (ARD, HSV, CMV) determines immunological disorder and severity of clinical manifestations.Группа исследования составила 47 детей в возрасте до 5 лет с тяжелыми респираторными заболеваниями, сочетанные с герпес инфекцией. Диагноз герпетической инфекции подтвержден методами ПЦР и ИФМ. Иммунологический дисбаланс отмечен у 2\3 случаев (снижение уровня СД8, СД4, СД20 и сывороточных фракций IgA и IgG). Подтверждено наличие HSV и\или CMV у родителей (методом ПЦР – 79% и ИФА – 11%). Вирусная ассоциация (ОРЗ, HSV, CMV) определяет иммунный дисбаланс и тяжесть клинического течения

Организационные проблемы контроля туберкулеза в Республике Молдова

Chiril Draganiuc Institute of Phtysiopulmonology, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaTuberculosis became an epidemic in the Republic of Moldova in the last century as a result of the socio-economic crisis, insufficient financing of healthcare, and the lack of anti-TB drugs. Due to the continuing deterioration of the epidemiological situation; the Government approved the National Tuberculosis Program (NTP) based on the DOTS strategy. The successful implementation of the NTP is only possible if all the sections of the strategy are performed, attaching special importance to the identification of patients with tuberculosis (TB) and their treatment on an outpatient basis. Since most of the TB patients first apply for medical assistance at institutions of general healthcare these have a good opportunity to establish a constructive relationship with the patient. The final outcome of TB treatment depends on the early detection and treatment of patients under the direct supervision (DOT). Unfortunately, the family doctor’s identification of TB patients with the bronchopulmonary pathology is not more than 60% of actual cases. Meanwhile, because of the duration of the chemotherapy (especially with MDR-TB) it is difficult to maintain the patient’s desire to comply with the potentially successful treatment. However, the health worker to whom the patient first applies at may be instrumental in creating a proper attitude toward his the therapy program. Frequent interruptions in treatment result in resistance to the drug. Healthcare workers should also pay close attention to the development of the patient’s psychiatric symptoms. Psychological support is often very effective, in the form of both individual psychiatric consultation and group therapy. The patient’s intake of alcohol and drugs needs to be assessed. Such patients require early detection of the effects of alcohol and drugs and direction to the specialized hospitals for joint treatment with psychiatrists and narcologists as they develop encephalopathy and suffer mental decline, often not only violating the regime to abuse alcohol, even in the hospital, but also to stop treatment completely. However, even with DOT some patients do not comply with treatment regimen. To ensure adherence, the healthcare professional must use the tactic of providing patients “means” and “incentives”: additional tickets for transportation, food parcels, etc., which contribute to the treatment’s efficacy. Should the patient want to discontinue treatment it is necessary to assess the severity of depression and the extent of drug or alcohol abuse and consider the use of means and incentives to foster patient compliance. This is the objective of the collaboration between family physicians and phthisiopneumologists in implementing the National Program for the early diagnosis and effective treatment of tuberculosis.Эволюция туберкулеза в Республике Молдова приобрела эпидемический характер в 90-х годах прошлого века и в связи с продолжающимся ухудшением эпидемиологической ситуации, начиная с 2001г. Правительство утверждает каждые 5 лет Национальную Программу по контролю над туберкулёзом. Национальные Противотуберкулезные Программы (НТП), основаны на стратегии DOTS. Успешная реализация НТП возможна только при условии выполнения всех разделов стратегии. Особое значение мы придаем участию Первичной медицинской сети (ПМС) в выявлении больных туберкулезом (ТБ) и их лечению в амбулаторных условиях под непосредственным контролем (ДОТ). К большому сожалению, выявление больных ТБ из числа обратившихся к семейному врачу с патологией бронхолегочного аппарата осуществляется не более чем, в 60% случаев. Необходимо уделить пристальное внимание развитию у пациента психиатрических симптомов. Психологическая поддержка часто оказывается очень действенной в виде посещения врача психиатра. Однако даже при применении DОТ часть пациентов не соблюдает режим лечения и не является для приема препаратов. У пациента, желающего прекратить лечение, необходимо оценить тяжесть депрессивного состояния и степень злоупотребления алкоголем или наркотиками. Следует обдумать возможность использования средств и стимулов, которые способны обеспечить соблюдение пациентом режима лечения. Такие больные требуют своевременного выявления последствий алкоголя и наркотиков, определения в специализированные стационары для совместного лечения с психиатрами или наркологами. Приведены конкретные задачи для совместной работы семейных врачей и фтизиопульмонологов в реализации Национальной Программы по ранней диагностике и эффективному лечению туберкулеза

Phase II study (KAMELEON) of single-agent T-DM1 in patients with HER2-positive advanced urothelial bladder cancer or pancreatic cancer/cholangiocarcinoma

The antibody-drug conjugate trastuzumab emtansine (T-DM1) is approved for human epidermal growth factor receptor 2 (HER2/ERBB2)-positive breast cancer. We aimed to study tumor HER2 expression and its effects on T-DM1 responses in patients with HER2-positive urothelial bladder cancer (UBC) or pancreatic cancer (PC)/cholangiocarcinoma (CC). In the phase II KAMELEON study (NCT02999672), HER2 status was centrally assessed by immunohistochemistry, with positivity defined as non-focal homogeneous or heterogeneous overexpression of HER2 in ≥30% of stained cells. We also performed exploratory biomarker analyses (e.g., gene-protein assay) on tissue samples collected from study participants and consenting patients who failed screening. Of the 284 patients successfully screened for HER2 status (UBC, n = 69; PC/CC, n = 215), 13 with UBC, four with PC, and three with CC fulfilled eligibility criteria. Due to recruitment difficulty, the sponsor terminated KAMELEON prematurely. Of the five responders in the UBC cohort (overall response rate, 38.5%), HER2 expression was heterogeneous in two and homogeneous in three. The one responder in the PC/CC cohort had PC, and the tumor displayed homogeneous expression. In the biomarker-evaluable population, composed of screen-failed and enrolled patients, 24.3% (9/37), 1.5% (1/66), and 8.2% (4/49) of those with UBC, PC, or CC, respectively, had HER2-positive tumors. In a gene-protein assay combining in situ hybridization with immunohistochemistry, greater HER2 homogeneity was associated with increased ERBB2 amplification ratio. In conclusion, KAMELEON showed that some patients with HER2-positive UBC or PC can respond to T-DM1 and provided insight into the prevalence of HER2 positivity and expression patterns in three non-breast tumor types.</p

News Accuracy in Switzerland and Italy

Nearly 80 years of accuracy research in the United States has documented that the press frequently errs, but empirical study about news accuracy elsewhere in the world is absent. This article presents an accuracy audit of Swiss and Italian daily regional newspapers. Replicating US research, the study offers a trans-Atlantic perspective of news accuracy. To compare newspaper accuracy in Switzerland and Italy to longitudinal accuracy research in the United States, the study followed closely the methodology pioneered by Charnley (1936) and adapted by Maier (2005). News sources found factual inaccuracy in 60 percent of Swiss newspaper stories they reviewed, compared to 48 percent of US and 52 percent of Italian newspapers examined. The results show that newspaper inaccuracy—and its corrosive effect on media credibility—transcends national borders and journalism cultures. Nowadays, digitization offers new ways of implementing correction policies. Media organizations need, however, to adapt to these changes and to adapt their structures in particular to new forms of participative and interactive two-way communication