Lung cancer--review

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenLung cancer is the second most common cancer in Iceland and the most frequent cause of cancer related deaths. Smoking is by far the most important cause but familial factors also contribute. The symptoms of lung cancer are often subtle and the diagnosis, in about 70% of cases, is made when metastases have occurred. Curative surgical treatment is therefore only possible in about a third of the cases whereas other patients receive chemotherapy and/or radiation therapy. In recent years some important advances have been made in the diagnostic and therapeutic approaches to lung cancer. New imaging techniques have improved diagnosis and staging practices and consequently also treatment. Recent evidence suggests that screening with low dose CT may improve survival. New approaches to chemotherapy have been shown to improve survival and well being of patients with advanced disease. Chemotherapeutic agents are now being used in conjunction with surgery to reduce the risk of tumour spread. Furthermore, advances in surgical techniques have made resections possible in cases deemed inoperable in the past. In this review we present important advances in the diagnosis and treatment of lung cancer as reflected by recent literature that should be of interest to a wide variety of specialists.Lungnakrabbamein er annað algengasta krabbameinið á Íslandi og það krabbamein sem dregur flesta Íslendinga til dauða. Orsökina má yfirleitt rekja beint til reykinga en erfðaþættir koma einnig við sögu. Einkenni lungnakrabbameins eru oft almenns eðlis. Sjúklingar greinast því oft seint og um 70% þeirra eru með meinvörp við greiningu. Skurðaðgerð í læknandi tilgangi kemur aðeins til greina í um þriðjungi tilfella en annars er beitt krabbameinslyfjum og/eða geislameðferð. Á síðustu árum hafa orðið framfarir í greiningu og meðferð lungnakrabbameins. Nýjungar í myndgreiningu auðvelda rannsóknir og stigun æxlanna og meðferð hefur því orðið markvissari. Margt bendir til þess að skimun með lágskammta tölvusneiðmyndum geti bætt horfur og lækkað dánartíðni. Nýjar tegundir krabbameinslyfja hafa bætt líðan og lengt líf sumra sjúklinga með útbreitt lungnakrabbamein. Þá er í vaxandi mæli farið að gefa krabbameinslyfjameðferð í tengslum við skurðaðgerðir, aðallega til að minnka líkur á því að krabbameinið nái að dreifa sér. Loks hafa nýjungar í skurðlækningum gert kleift að fjarlægja æxli sem áður voru talin óskurðtæk. Í þessari yfirlitsgrein eru helstu nýjungar í greiningu og meðferð lungnakrabbameins reifaðar. Byggt er á nýjustu þekkingu og heimildum en greinin er skrifuð með lækna úr sem flestum sérgreinum í huga

Microencapsulation of ammodaucus leucotrichus essential oil using chitosan/ TPP/vanillin chemical system

A. leucotrichus (Coss. & Dur.) Coss. & Dur., known in Algeria as “Kammûnes-sofi”, is a medicinal plant that finds culinary use by indigenous populations. Among others, it is used against stomach pain, indigestion, diarrhea, vomiting, fever, and to combat high blood pressure. In this work, the essential oil of A. leucotrichus, obtained by steam distillation (3h) from fruits collected in March 2015 from Tassili n'Ajjer, a vast plateau in south-east Algeria (25°30'0" N and 9°0'0" E), was chemically and biologically characterized and thereafter microencapsulated using a chitosan/TPP/vanillin system.A. leucotrichus essential oil microparticles were produced using an atomization/coagulation technique with chitosan as the shell material, sodium tripolyphosphaste (TPP) and vanillin as crosslinking agents. Comparatively to the most used chemical systems, this one presents several advantages since all the raw materials are nontoxic and no organic solvents are required. Moreover, the used microencapsulation process allows the microparticles production in a single step, without having the constrains of the traditionally used oil-in-water (o/w) emulsion based techniques. The adopted procedure comprises the following stages: (1) Chitosan solution (CS) preparation (3.0%, w/v) in acidic medium (acetic acid 3%, v/v); (2) Oil-in-water (o/w) emulsion preparation by emulsifying the essential oil (O) with the chitosan solution at O/CS ratio of 0.025 (v/v) with Tween 80 (emulsifier of HLB=15.0, 1.5%, w/v). The emulsion was homogenized at 11000 rpm during 5 min with a CAT Unidrive X homogenizer; (3) Atomization of the o/w emulsion in a Nisco VarJ30 system (flow rate: 0.3 ml/min) under pressurized nitrogen; (4) Coagulation with TPP (10%, w/v at pH 6.0) followed by vanillin crosslinking (1.0% (w/v), 50ºC at 0.5 ml/min during 2 h). Microparticles were recovered by filtration under reduced pressure, washed with distilled water and stored in the hydrated form.info:eu-repo/semantics/publishedVersio

Understanding posttraumatic growth of paratriathletes with acquired disability

Purpose: To examine the relevance of key components of Organismic Valuing Theory of Growth through Adversity in understanding posttraumatic growth amongst paratriathletes with acquired disability. Methods: Semi-structured interviews informed by organismic valuing theory of growth through adversity were conducted with 14 elite paratriathletes (8 male, 6 female). To increase the likelihood that participants had experienced posttraumatic growth, a short form of the Posttraumatic Growth Inventory was completed prior to interview participation. Interview data were analyzed using directed content analysis. Results: Although the initial response to disability was largely negative, paratriathlon experiences were reported to be a mechanism through which growth was facilitated. In particular, participants suggested that social, competence, empowerment, and identity development processes were instrumental in facilitating posttraumatic growth. Conclusions: Analysis identified themes largely consistent with the main tenets of organismic valuing theory of growth through adversity, supporting its utility in understanding response to a traumatic event and subsequent growth. These findings also suggest that para sport may be an efficacious means for promoting posttraumatic growth, especially for individuals with severe initial reactions to their disability. Lastly, findings suggest that fostering perceptions of competence, autonomy, and social connection may promote posttraumatic growth

Joint Custody in the Italian Courts

This paper studies the impact of the introduction of joint custody in Italy (Law 54/2006) on judiciary outcomes. As to the formal (legal) assignment of joint custody, the reform envisaged very little judge discretion. With reference to the substance of the custody (the amount of time each parent spends with the child and the money involved in post-dissolution arrangements), the law established new principles while leaving plenty of implementation power to the judges. Our results - based on court data that covers the universe of separations from 2000 to 2010 - document that the law was only cosmetically applied by the judges. Compared to the pre-reform regime, the share of sole legal custody assignments to the mother drastically decreased. However, court implementation washed out the new principles: the provisions of the law related to the financial post-separation arrangements remained unapplied. This suggests that the main innovative aspect of the law - the possibility for a child to spend an adequate amount of time with both parents - was also left unchanged with respect to the previous regime of sole maternal custody. As joint effect of the introduction of the law and the little degree to which the new principles have been translated into actual verdicts, there was a surge in litigiousness among separating spouses and judicial inefficiency. Moreover, the incentives for a female partner to apply for a separation raised. The paper discusses a possible rationale for the findings and some related policy remedies. As for the former, the evidence we present can be explained by the adoption of gender-biased judiciary practices. As for the latter, our results suggest that a restatement of the law, to define a narrowed grid of prescriptions that constrain judge discretion, could be an effective corrective action

Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta‑analysis

Background Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave’s syndrome (BS). Methods We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. Results Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8–5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2–7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2–6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p < 0.001), compared with late TOD. In BS, no associations between TOD and outcomes were found. When combining IEP and BS, early TOD was associated with a 6% decrease in overall mortality (10% vs. 16%, OR 2.1, 95% CI 1.1–3.9), a 19% decrease in re-interventions (26% vs. 45%, OR 1.9, 95% CI 1.1–3.2) and a 35% decrease in mean length of hospital stay (16 vs. 22 days, p = 0.001), compared with late TOD. Conclusions This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome.publishedVersio

Employed But Still Unhappy? On the Relevance of the Social Work Norm

In the modern welfare state, people who cannot make a living usually receive financial assistance from public funds. Accordingly, the so-called social work norm against living off other people is violated, which may be the reason why the unemployed are so unhappy. If so, however, labour market concepts based on the notion of promoting low-paid jobs that are subsidised if necessary with additional payments would appear far less favourable. It could be that people are employed, but still unhappy. Using German panel data, this paper examines the relevance of the social work norm and finds a significant disutility effect of living off public funds. Although this is true for employed people as well, the results show that the individual is generally better off having a job that requires additional assistance, than having no job at all. On the other hand, such policies as the recent German labour market reforms can trigger undesired side-effects, if policy-makers ignore the issue of the social work norm

Molecular residual disease detection in resected, muscle-invasive urothelial cancer with a tissue-based comprehensive genomic profiling–informed personalized monitoring assay

IntroductionCirculating tumor DNA (ctDNA) detection postoperatively may identify patients with urothelial cancer at a high risk of relapse. Pragmatic tools building off clinical tumor next-generation sequencing (NGS) platforms could have the potential to increase assay accessibility.MethodsWe evaluated the widely available Foundation Medicine comprehensive genomic profiling (CGP) platform as a source of variants for tracking of ctDNA when analyzing residual samples from IMvigor010 (ClinicalTrials.gov identifier NCT02450331), a randomized adjuvant study comparing atezolizumab with observation after bladder cancer surgery. Current methods often involve germline sampling, which is not always feasible or practical. Rather than performing white blood cell sequencing to filter germline and clonal hematopoiesis (CH) variants, we applied a bioinformatic approach to select tumor (non-germline/CH) variants for molecular residual disease detection. Tissue-informed personalized multiplex polymerase chain reaction–NGS assay was used to detect ctDNA postsurgically (Natera).ResultsAcross 396 analyzed patients, prevalence of potentially actionable alterations was comparable with the expected prevalence in advanced disease (13% FGFR2/3, 20% PIK3CA, 13% ERBB2, and 37% with elevated tumor mutational burden ≥10 mutations/megabase). In the observation arm, 66 of the 184 (36%) ctDNA-positive patients had shorter disease-free survival [DFS; hazard ratio (HR) = 5.77; 95% confidence interval (CI), 3.84–8.67; P &lt; 0.0001] and overall survival (OS; HR = 5.81; 95% CI, 3.41–9.91; P &lt; 0.0001) compared with ctDNA-negative patients. ctDNA-positive patients had improved DFS and OS with atezolizumab compared with those in observation (DFS HR = 0.56; 95% CI, 0.38–0.83; P = 0.003; OS HR = 0.66; 95% CI, 0.42–1.05). Clinical sensitivity and specificity for detection of postsurgical recurrence were 58% (60/103) and 93% (75/81), respectively.ConclusionWe present a personalized ctDNA monitoring assay utilizing tissue-based FoundationOne® CDx CGP, which is a pragmatic and potentially clinically scalable method that can detect low levels of residual ctDNA in patients with resected, muscle-invasive bladder cancer without germline sampling

Deciphering the pathogenesis of tendinopathy: a three-stages process

Our understanding of the pathogenesis of "tendinopathy" is based on fragmented evidences like pieces of a jigsaw puzzle. We propose a "failed healing theory" to knit these fragments together, which can explain previous observations. We also propose that albeit "overuse injury" and other insidious "micro trauma" may well be primary triggers of the process, "tendinopathy" is not an "overuse injury" per se. The typical clinical, histological and biochemical presentation relates to a localized chronic pain condition which may lead to tendon rupture, the latter attributed to mechanical weakness. Characterization of pathological "tendinotic" tissues revealed coexistence of collagenolytic injuries and an active healing process, focal hypervascularity and tissue metaplasia. These observations suggest a failed healing process as response to a triggering injury. The pathogenesis of tendinopathy can be described as a three stage process: injury, failed healing and clinical presentation. It is likely that some of these "initial injuries" heal well and we speculate that predisposing intrinsic or extrinsic factors may be involved. The injury stage involves a progressive collagenolytic tendon injury. The failed healing stage mainly refers to prolonged activation and failed resolution of the normal healing process. Finally, the matrix disturbances, increased focal vascularity and abnormal cytokine profiles contribute to the clinical presentations of chronic tendon pain or rupture. With this integrative pathogenesis theory, we can relate the known manifestations of tendinopathy and point to the "missing links". This model may guide future research on tendinopathy, until we could ultimately decipher the complete pathogenesis process and provide better treatments