Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

BACKGROUND: This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. METHODS: A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. RESULTS: Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. CONCLUSION: For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently considered in clinical practice when applying this evidence such as the effect of primary histology, anatomical site of treatment, risk of pathological fracture, soft tissue disease and cord compression, use of antiemetics, and the role of retreatment are discussed as qualifying statements. Our systematic review and meta-analysis provided high quality evidence for the key recommendation in this clinical practice guideline. Qualifying statements addressing factors that should be considered when applying this recommendation in clinical practice facilitate its clinical application. The rigorous development and approval process result in a final document that is strongly endorsed by practitioners as a practice guideline

The erlins are novel members of the prohibitin family of proteins that define lipid raft microdomains of the endoplasmic reticulum

Bibliography: p. 231-271Some pages are in colour

Материалы к танатогенезу при острой кишечной непроходимости. (Предварительное сообщение)

Non-nutritive sweeteners (NNSs) are widely used in various food products and soft drinks. There is growing evidence that NNSs contribute to metabolic dysfunction and can affect body weight, glucose tolerance, appetite, and taste sensitivity. Several NNSs have also been shown to have major impacts on bacterial growth both in vitro and in vivo. Here we studied the effects of various NNSs on the growth of the intestinal bacterium, E. coli, as well as the gut bacterial phyla Bacteroidetes and Firmicutes, the balance between which is associated with gut health. We found that the synthetic sweeteners acesulfame potassium, saccharin and sucralose all exerted strong bacteriostatic effects. We found that rebaudioside A, the active ingredient in the natural NNS stevia, also had similar bacteriostatic properties, and the bacteriostatic effects of NNSs varied among different Escherichia coli strains. In mice fed a chow diet, sucralose increased Firmicutes, and we observed a synergistic effect on Firmicutes when sucralose was provided in the context of a high-fat diet. In summary, our data show that NNSs have direct bacteriostatic effects and can change the intestinal microbiota in vivo

The NNS sucralose alters gut microbiota in mice.

<p>(A) <i>Alpha</i> diversity of gut microbiota for the diets used. (B) The abundances of the major phyla of gut microbiota after various diets. (C) Relative changes in abundance of major microbiota phyla in chow fed mice. (D) Relative changes in abundance of major microbiota phyla in HFD fed mice. (E) Relative changes in genus of <i>Clostridium</i> and <i>Bifidobacterium</i> in chow fed mice. (F) Relative changes in genus of <i>Clostridium</i> and <i>Bifidobacterium</i> in HFD fed mice. All data n = 8 mice per group represented mean ± S.E.M., Two-way analysis of variance (ANOVA) with Bonferroni’s test for multiple comparisons was used. * p <0.05, n.s., not significant.</p

Sucralose promotes faecal excretion in mice.

<p>(A) Schematic for the mouse study. (B) Sucralose intake. (C) Body weight. (D) Food intake. (E) Calories intake. (F) Water intake. (G) Faecal weight. All data n = 8 mice per group, represented as mean ± S.E.M., two-way analysis of variance (ANOVA) with Bonferroni’s test for multiple comparisons was used. *p<0.05, ****p <0.0001, n.s., not significant.</p

The natural NNS reb A possesses a selective bacteriostatic effect on <i>E</i>. <i>coli in vitro</i>.

<p>Reb A (2.5%, w/v) inhibited the growth of <i>E</i>. <i>coli</i> HB101 colonies (A, B), but not <i>E</i>. <i>coli</i> K-12 colonies (A, C), n = 3. All data represent mean ± S.E.M., Wilcoxon match-pairs signed rank test was used. * p<0.05. n.s., not significant.</p