In-vivo longitudinal MRI study: an assessment of melanoma brain metastases in a clinically relevant mouse model.

Brain metastases are an important clinical problem. Few animal models exist for melanoma brain metastases; many of which are not clinically relevant. Longitudinal MRI was implemented to examine the development of tumors in a clinically relevant mouse model of melanoma brain metastases. Fifty thousand human metastatic melanoma (A2058) cells were injected intracardially into nude mice. Three Tesla MRI was performed using a custom-built gradient insert coil and a mouse solenoid head coil. Imaging was performed on consecutive days at four time points. Tumor burden and volumes of metastases were measured from balanced steady-state free precession image data. Metastases with a disrupted blood-tumor barrier were identified from T1-weighted spin echo images acquired after administration of gadopentetic acid (Gd-DTPA). Metastases permeable to Gd-DTPA showed signal enhancement. The number of enhancing metastases was determined by comparing balanced steady-state free precession images with T1-weighted spin echo images. After the final imaging session, ex-vivo permeability and histological analyses were carried out. Imaging showed that both enhancing and nonenhancing brain metastases coexist in the brain, and that most metastases switched from the nonenhancing to the enhancing phenotype. Small numbers of brain metastases were enhancing when first detected by MRI and remained enhancing, whereas other metastases remained nonenhancing to Gd-DTPA throughout the experiment. No clear relationship existed between the permeability of brain metastases and size, brain location and age. Longitudinal in-vivo MRI is key to studying the complex and dynamic processes of metastasis and changes in the blood-tumor barrier permeability, which may lead to a better understanding of the variable responses of brain metastases to treatments

Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004–2013

Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

Determinants and effects of sexual exploitation among female students of tertiary institutions in Rivers State

Background: Labor induction methods are continuously evolving to ensure safer and more effective outcomes for both mother and neonate. The present study aimed to assess the effectiveness and safety of combined use of misoprostol with intracervical catheter for labor induction. Methods: This single-blinded, parallel-group randomized control trial conducted at Shaheed Suhrawardy Medical College, Dhaka, Bangladesh, included 200 women with term gestation and Bishop score ≤6. Participants were divided into two groups: the intervention group (group B) received misoprostol juice and Foley’s catheter, while the control group (group A) received misoprostol in the posterior fornix. Results: In Group A, 58% had vaginal deliveries, while in Group B, 65% had vaginal deliveries. Group B experienced a longer mean length of labor in the 1st stage (13.25±1.095) compared to Group A (12.98±1.982, p=0.008). The 3rd stage was shorter for Group B (10.00±0.000) than Group A (12.02±2.469, p<0.001). The most common induction reason was labor pain with an unfavorable cervix (31 in Group A and 33 in Group B). Group B had a higher percentage of inductions at less than 12 hours and a lower percentage at more than 24 hours. Neonatal outcomes were generally better for Group B. The Cox regression hazard model showed a lower likelihood of positive outcomes in Group B (hazard ratio 0.337, 95% CI 0.243-0.469, p=0.000), indicating a statistically significant difference between the groups. Conclusions: The combined use of misoprostol with Foley’s catheter for labor induction is safe and effective, resulting in shorter labor duration and higher rates of vaginal delivery compared to misoprostol alone

Classic and modern in the therapy of hepatic hidatid cysts – experience of a general surgery center

Clinica II Chirurgie, Spitalul Județean de Urgențe ”Sf. Spiridon”, Iași UMF ”Gr.T. Popa” Iași, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011INTRODUCERE. În ultimii 20 de ani, asistăm la o tendință de afirmare a terapiilor mai puțin invazive pentru pacienții cu chist hidatic hepatic (radiologie intervențională, endoscopie intervențională, puncții eco sau CT-ghidate, tehnici chirurgicale laparoscopice precum şi asocieri ale acestora). SCOP. Ne-am propus o comparație între rezultatele după abordul clasic şi cel minim-invaziv pentru tratamentul echinococozei hepatice. MATERIAL ŞI METODĂ. Au fost analizate retrospectiv 180 cazuri de chist hidatic hepatic operate în Clinica I Chirurgie Iaşi, România în perioada 2004-2010. Au fost selectate pentru analiză următoarele variabile: localizarea chistului, tipul acestuia (conform clasificării propuse de Informal Working Group on Echinococcosis), calea de abord, tehnica chirurgicală, durata evoluției postoperatorii, complicațiile survenite, recidivele şi asocierea chimioterapiei antiparazitare. Pentru analiza statistică s-au folosit testele neparametrice Mann-Whitney U şi Spearman cu pragul de semnificație p<0.05. REZULTATE. Leziunile s-au tratat prin puncție echoghidată (n=6;3.3%); pe cale laparoscopică (n= 48;26.6%) şi abord clasic (n=126;70.1%). Pe cale laparoscopică s-au efectuat: inactivare-aspirație-drenaj şi inactivare-aspirație-perichistectomie parțială. Pe cale clasică s-au practicat: inactivare-aspirație-drenaj, inactivare-aspirație-perichistectomie parțială, perichistectomie ideală, hepatectomie reglată, hepatectomie atipică. Abordul minim-invaziv se corelează semnificativ cu tipul I-II al chisturilor (p=0.016) şi cu localizarea acestora în segmentele II, III şi VI (p=0.001). Durata evoluției postoperatorii a fost semnificativ mai redusă după abordul laparoscopic (p=0.003) comparativ cu cea după intervențiile clasice „minimale” (inactivare-aspirație-drenaj şi inactivare-aspirație-perichistectomie parțială) practicate pentru leziunile tip I-III, dar diferența dintre numărul de zile de îngrijiri după abordul laproscopic vs. chirurgie radicală (perichistectomie ideală, hepatectomie) este nesemnificativă. Nu am întâlnit corelații semnificative între apariția recidivelor/complicațiilor şi tipul de abord. Chimioterapia antiparazitară, instituită în 118 de cazuri (65.5%), se corelează semnificativ cu o rată redusă a recidivelor survenite în 9 cazuri (5%). CONCLUZII. Boala hidatică beneficiază astăzi de o terapie multimodală în care chimioterapia, PAIR-ul, videochirurgia şi chirurgia clasică trebuie să se completeze cât mai fericit şi nu să se excludă. Chiar dacă „pierde din indicații”, chirurgia clasică rămâne „rezerva strategică” în terapia chistului hidatic.INTRODUCTION. In the last 20 years, we noticed an outstanding of less invasive therapy for the patients with hidatid disease (interventional radiology, interventional endoscopy, eco- or CT punctions, laparoscopy and association between these). AIM. We intend to compare the results after classic and laparoscopic approach as treatment for hepatic echinococcosis. METHODS. We analysed 180 cases operated in 1st Surgical Clinic, Iasi, Romania, between 2004-200. We recorded the fallowing parameters: location, type (classification approved by Informal Working Group on Echinococcosis), approaching type, surgical technique, postoperative evolution, complications, recurrences and chemotherapy. We used Mann-Whitney U and Spearman tests (p<0.05).RESULTS. The cases were solved by eco guidance punction (n=6; 3.3%); laparoscopic (n= 48; 26.6%) and classic approach (n=126; 70.1%). Minim invasive approach we did inactivation-suction-drainage and partial perichistectomy. Using open approach we did inactivation-suction-drainage, partial perichistectomy, total perichistectomy and hepatectomy. Laparoscopic treatment has significant correlation with type I-II (p=0.016) located in segments II, III and IV (p=0.001). Postoperative evolution is significant lower for laparoscopic methods (p=0.003) comparing with the „minimal” open techniques used for lesions type I-III. There is no significant differentiation between laparoscopic procedures and open radical surgery (total perichistectomy and hepatectomy). We did not register significant correlations about recurrences and complications. Chemotherapy used in 8 cases is correlated with a low rate of recurrence 9 cases (5%).CONCLUSIONS. Hidatid disease has the benefits of a multimodal therapy. Chemotherapy, PAIR, video surgery and open approach are completing themselves and not excluding each other. Even if classic methods are less frequent used, it remains as a „back up solution” in the therapy of hidatid cyst disease

Methodological framework for World Health Organization estimates of the global burden of foodborne disease

Background: The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization to estimate the global burden of foodborne diseases (FBDs). This paper describes the methodological framework developed by FERG's Computational Task Force to transform epidemiological information into FBD burden estimates. Methods and Findings: The global and regional burden of 31 FBDs was quantified, along with limited estimates for 5 other FBDs, using Disability-Adjusted Life Years in a hazard- and incidence-based approach. To accomplish this task, the following workflow was defined: outline of disease models and collection of epidemiological data; design and completion of a database template; development of an imputation model; identification of disability weights; probabilistic burden assessment; and estimating the proportion of the disease burden by each hazard that is attributable to exposure by food (i.e., source attribution). All computations were performed in R and the different functions were compiled in the R package 'FERG'. Traceability and transparency were ensured by sharing results and methods in an interactive way with all FERG members throughout the process. Conclusions: We developed a comprehensive framework for estimating the global burden of FBDs, in which methodological simplicity and transparency were key elements. All the tools developed have been made available and can be translated into a user-friendly national toolkit for studying and monitoring food safety at the local level

Identifying the women most vulnerable to intimate partner violence: a decision tree analysis from 48 low and middle-income countries

Background Primary prevention strategies are needed to reduce high rates of intimate partner violence (IPV) in low- and middle-income countries (LMICs). The effectiveness of population-based approaches may be improved by adding initiatives targeted at the most vulnerable groups and tailored to context-specificities. Methods We applied a decision-tree approach to identify subgroups of women at higher risk of IPV in 48 LMICs and in all countries combined. Data from the most recent Demographic and Health Survey carried out between 2010 and 2019 with available information on IPV and sociodemographic indicators was used. To create the trees, we selected 15 recognized risk factors for IPV in the literature which had a potential for targeting interventions. Exposure to IPV was defined as having experienced physical and/or sexual IPV in the past 12 months. Findings In the pooled decision tree, witnessing IPV during childhood, a low or medium empowerment level and alcohol use by the partner were the strongest markers of IPV vulnerability. IPV prevalence amongst the most vulnerable women was 43% compared to 21% in the overall sample. This high-risk group included women who witnessed IPV during childhood and had lower empowerment levels. These were 12% of the population and 1 in 4 women who experienced IPV in the selected LMICs. Across the individual national trees, subnational regions emerged as the most frequent markers of IPV occurrence. Interpretation Starting with well-known predictors of IPV, the decision-tree approach provides important insights about subpopulations of women where IPV prevalence is high. This information can help designing targeted interventions. For a large proportion of women who experienced IPV, however, no particular risk factors were identified, emphasizing the need for population wide approaches conducted in parallel, including changing social norms, strengthening laws and policies supporting gender equality and women´s rights as well as guaranteeing women´s access to justice systems and comprehensive health services. Funding Bill and Melinda Gates Foundation (Grant INV-010051/OPP1199234), Wellcome Trust (Grant Number: 101815/Z/13/Z ) and Associação Brasileira de Saúde Coletiva (ABRASCO)

System-level policies on appropriate opioid use, a multi-stakeholder consensus

Background:  This consensus statement was developed because there are concerns about the appropriate use of opioids for acute pain management, with opposing views in the literature. Consensus statement on policies for system-level interventions may help inform organisations such as management structures, government agencies and funding bodies. Methods:  We conducted a multi-stakeholder survey using a modified Delphi methodology focusing on policies, at the system level, rather than at the prescriber or patient level. We aimed to provide consensus statements for current developments and priorities for future developments. Results:  Twenty-five experts from a variety of fields with experience in acute pain management were invited to join a review panel, of whom 23 completed a modified Delphi survey of policies designed to improve the safety and quality of opioids prescribing for acute pain in the secondary care setting. Strong agreement, defined as consistent among> 75% of panellists, was observed for ten statements. Conclusions:  Using a modified Delphi study, we found agreement among a multidisciplinary panel, including patient representation, on prioritisation of policies for system-level interventions, to improve governance, pain management, patient/consumers care, safety and engagement.Publisher PDFPeer reviewe

An Evaluation of the Precision of Measurement of Ryff’s Psychological Well-Being Scales in a Population Sample

The aim of this study is to assess the effective measurement range of Ryff’s Psychological Well-being scales (PWB). It applies normal ogive item response theory (IRT) methodology using factor analysis procedures for ordinal data based on a limited information estimation approach. The data come from a sample of 1,179 women participating in a midlife follow-up of a national birth cohort study in the UK. The PWB scales incorporate six dimensions: autonomy, positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance. Scale information functions were calculated to derive standard errors of measurement for estimated scores on each dimension. Construct variance was distinguished from method variance by inclusion of method factors from item wording (positive versus negative). Our IRT analysis revealed that the PWB measures well-being most accurately in the middle range of the score distribution, i.e. for women with average well-being. Score precision diminished at higher levels of well-being, and low well-being was measured more reliably than high well-being. A second-order well-being factor loaded by four of the dimensions achieved higher measurement precision and greater score accuracy across a wider range than any individual dimension. Future development of well-being scales should be designed to include items that are able to discriminate at high levels of well-being

Problem formulation in the environmental risk assessment for genetically modified plants

Problem formulation is the first step in environmental risk assessment (ERA) where policy goals, scope, assessment endpoints, and methodology are distilled to an explicitly stated problem and approach for analysis. The consistency and utility of ERAs for genetically modified (GM) plants can be improved through rigorous problem formulation (PF), producing an analysis plan that describes relevant exposure scenarios and the potential consequences of these scenarios. A properly executed PF assures the relevance of ERA outcomes for decision-making. Adopting a harmonized approach to problem formulation should bring about greater uniformity in the ERA process for GM plants among regulatory regimes globally. This paper is the product of an international expert group convened by the International Life Sciences Institute (ILSI) Research Foundation