Treatment related morbidity in breast cancer patients

Background: Sentinel lymph node biopsy (SLNB) was introduced for staging of the axilla to reduce the number of unnecessary axillary lymph node dissections (ALND’s) and proved to be an accurate and safe procedure to predict metastatic disease in clinically negative axillary lymph nodes. SLNB was expected to have less treatment related morbidity in comparison to ALND. In a multicenter prospective cohort study, long term upper-limb morbidity, perceived disabilities in activities of daily life (ADL) and quality of life (QOL) were assessed before and six weeks, 12 month and 24 month after SLNB or ALND for breast cancer. - \ud Methods: 204 patients with stage I/II breast cancer, mean age 55.6 years (sd: 11.6) entered the study and 181 patients (89%) could be evaluated after two years. Sixty-six patients (32%) underwent SLNB only, and 138 (68%) underwent a level I-II ALND. Reliable and valid assessment instruments were used for assessment of upper limb morbidity, ADL and QOL. Assessment included evaluation of shoulder range of motion, muscle strength, grip strength, pain, upper/forearm circumference, shoulder disability and activities of daily life (ADL) and Quality of Live. - \ud Results: Considerable treatment related upper-limb morbidity was observed. Significant (p<0.05) changes between before and up till two years after surgery were found in almost all assessments of shoulder function, ADL and several QOL subscales. Patients in the ALND group showed significant more changes in range of motion (ROM), grip strength, arm volume, ADL and QOL physical- and role functioning, pain and sleeplessness and arm symptoms compared to the SLNB group. Upper limb morbidity and associated disabilities in ADL are at worse in the early stage (first months) after surgical treatment. Concerning arm edema; in the ALND group arm volume increased significantly at 1 and 2 years follow up. Concerning QOL, significantly differences in mean change over the two years comparing SLNB with ALND were found for physical and role functioning and also for symptom items such as pain, insomnia (sleeplessness) and arm symptoms in favor of the SLNB group. QOL in the SLNB group was just improving in the 2 years after treatment whereas in de ALND group only emotional functioning and future perspective improved. Multivariate linear regression analysis showed that radiation therapy on the axilla is besides ALND an important factor in the prediction of impaired shoulder ROM and arm edema. Radiation therapy on the breast had no influence on shoulder ROM. - \ud Conclusion: 1. Significant treatment related short-term, middle-term and long-term upper limb morbidity and perceived disabilities in ADL and long-term reduction of QOL exist in breast cancer patients. 2. In the assessment of changes in upper limb function, ADL and QOL, ALND is the most frequent found predictor of deterioration. Additional radiation therapy on the axilla predicts a further decrease in shoulder ROM and arm edema. 3. Long-term upper limb morbidity is significantly correlated with disabilities in ADL and worsening of QOL

Bent asymmetric Y-branch integrated optical broadband wavelength multi/demultiplexer

A new integrated optic wavelength multi/demultiplexer based on a bent asymmetric Y-branch is proposed and investigated. The broadband multi/demultiplexer is demonstrated to combine/split 660 nm pump light and 1535 nm signal light with coupling efficiencies of about 85% and 95% respectively, which is useful for erbium doped integrated optic lasers. The bent Y-branch multi/demultiplexer is simple to fabricate and rather insensitive to processing variations

Adherence to a Treat-to-Target Strategy in Early Rheumatoid Arthritis: Results of the DREAM Remission Induction Cohort

Introduction\ud Clinical trials have demonstrated that treatment-to-target (T2T) is effective in achieving remission in early rheumatoid arthritis (RA). However, the concept of T2T has not been fully implemented yet and the question is whether a T2T strategy is feasible in daily clinical practice. The objective of the study was to evaluate the adherence to a T2T strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6) in early RA in daily practice. The recommendations regarding T2T included regular assessment of the DAS28 and advice regarding DAS28-driven treatment adjustments. \ud \ud Methods\ud A medical chart review was performed among a random sample of 100 RA patients of the DREAM remission induction cohort. At all scheduled visits, it was determined whether the clinical decisions were compliant to the T2T recommendations. \ud \ud Results\ud The 100 patients contributed to a total of 1,115 visits. The DAS28 was available in 97.9% (1,092/1,115) of the visits, of which the DAS28 was assessed at a frequency of at least every three months in 88.3% (964/1,092). Adherence to the treatment advice was observed in 69.3% (757/1,092) of the visits. In case of non-adherence when remission was present (19.5%, 108/553), most frequently medication was tapered off or discontinued when it should have been continued (7.2%, 40/553) or treatment was continued when it should have been tapered off or discontinued (6.2%, 34/553). In case of non-adherence when remission was absent (42.1%, 227/539), most frequently medication was not intensified when an intensification step should have been taken (34.9%, 188/539). The main reason for non-adherence was discordance between disease activity status according to the rheumatologist and DAS28. \ud \ud Conclusions\ud The recommendations regarding T2T were successfully implemented and high adherence was observed. This demonstrates that a T2T strategy is feasible in RA in daily clinical practic

Synthesis of Pyridinium Amphiphiles Used for Transfection and Some Characteristics of Amphiphile/DNA Complex Formation

Pyridinium amphiphiles have found practical use for the delivery of DNA into cells. Starting from 4-methylpyridine, a general synthesis has been devised for the production of pyridinium amphiphiles which allows variation in both the hydrophobic part and in the headgroup area of the compounds. By means of differential scanning microcalorimetry, zeta potential, particle size measurements and cryo electron microscopy, some characteristics of the pyridinium amphiphile/ DNA complexes have been determined.

Вплив техногенного чинника на формування скупчень метану в пісковиках

Исследовано влияние горных работ в процессе добычи угля на физические свойства песчаников по результатам опробования керна геологоразведочных скважин и горных выработок. Установлено, что коэффициент открытой пористости песчаников, в зоне влияния горных работ существенно отличается от соответствующих показателей в нетронутом массиве. Показано, что такое разуплотнение, за счёт трещинообразвания, способствует увеличению открытой пористости песчаников в 1,2-1,4 раза и формированию проницаемости, соответствующей коллекторам III-IV класса.Influence of mining operations has been investigated in the coal mining process on physical properties of sandstones, on results of core assay of geological prospecting holes and mining workings. It was set that open porosity coefficient of sandstones, in the affected zone of mining operations substantially differs from the proper indexes in natural array. It is shown, that such volume expension due to cracks formation, promotes increasing of sandstones open porosity in 1,2-1,4 time and forming of permeability corresponding of the III-IV class collectors