63P Ocena skuteczności paliatywnej brachyterapii HDR w leczeniu raka przełyku

Celem pracy jest ocena skuteczności paliatywnej brachyterapii w leczeniu zaawansowanego raka przełyku. Poddano analizie wpływ wcześniejszej teleradioterapii na efekt paliacji oraz dokonano oceny przydatności powtórnej brachyterapii w leczeniu nawrotu dysfagii.Materiał i metodyW latach 1991–1997 w Instytucie Onkologii w Gliwicach leczono brachyterapią HDR 35 chorych na zaawansowanego raka przełyku. 23 chorych tej grupy było uprzednio leczonych z zastosowaniem zewnętrznych źródeł promieniowania, dla 12 brachyterapia była jedyną metodą leczenia. U 9 chorych tej grupy zastosowano ponownie brachyterapię w leczeniu nawrotu dysfagii. Skuteczność paliatywnej brachyterapii oceniono na podstawie analizy pięciu czynników:•subiektywnego odczucia poprawy•stopnia dysfagii po leczeniu•bólu przy przełykaniu•wzrostu wagi•regresji radiologicznej zmianyW celu analizy wpływu teleradioterapii na skuteczność paliatywnej brachyterapii chorzy zostali podzieleni na dwie grupy A i B. Do grupy A zaliczono chorych leczonych uprzednio teleradioterapią, do grupy B zaliczono chorych leczonych wyłącznie brzchyterapią.WynikiSubiektywną poprawę po leczeniu zgłaszało 28 (80%) chorych. U 31 chorych nastąpiło zmniejszenie dysfagii. Spośród 14(40%) chorych cierpiących z powodu bólu u 6 (42%) chorych stwierdzono zmniejszenie nasilenia tego objawu. Ból nie był częstym objawem w badanej grupie. 21 (60%) chorych nie odczuwało bólu zarówno przed jak i po leczeniu. U 14 (40%) chorych stwierdzono wzrost wagi po leczeniu, a u 20 (57%) chorych waga utrzymywała się na stałym poziomie. W skopii przełyku z kontrastem stwierdzono regresję zmiany u 29 (83%) chorych. Czas trwania regresji objawów wahał się od kilkunastu dni do półtora roku; średnio wynosił 2,5 miesiąca. Ciężkie powikłania po leczeniu zaobserwowano u 6 (17%) chorych. W grupach A i B stwierdzono porównywalny efekt paliatywny, ciężkie powikłania zaobserwowano jednak tylko u chorych zaliczonych do grupy A.Spośród 9 chorych leczonych z powodu nawrotu dysfagii powtórna brachyterapia przyniosła efekt u 5 (56%) chorych. powikłania po powtórnej brachyterapii zaobserwowano u 3chorych; wszyscy byli uprzednio leczeni teradioterapią.WnioskiBrachyterapia HDR jest skuteczną metodą paliatywnego leczenia raka przełyku i wydaje się być wystarczająca jako jedyna metoda paliacji przy tym rozpoznaniu. W badanej grupie powtórne zastosowanie brachyterapii okazało się skuteczna metodą w przypadku nawrotu dysfagii u chorych nie poddanych wcześniej teleradioterapii

One-dimensional quasi-relativistic particle in the box

Two-term Weyl-type asymptotic law for the eigenvalues of one-dimensional quasi-relativistic Hamiltonian (-h^2 c^2 d^2/dx^2 + m^2 c^4)^(1/2) + V_well(x) (the Klein-Gordon square-root operator with electrostatic potential) with the infinite square well potential V_well(x) is given: the n-th eigenvalue is equal to (n pi/2 - pi/8) h c/a + O(1/n), where 2a is the width of the potential well. Simplicity of eigenvalues is proved. Some L^2 and L^infinity properties of eigenfunctions are also studied. Eigenvalues represent energies of a `massive particle in the box' quasi-relativistic model.Comment: 40 pages, 4 figures; minor correction

Perforacja jelit jako powikłanie chemioterapii ostrej białaczki limfoblastycznej u dzieci – opis dwóch przypadków

Wielolekowa chemioterapia stanowi podstawę współczesnych metod leczenia nowotworów układu krwiotwórczego u dzieci. Stosując poszczególne grupy leków, należy mieć na uwadze ewentualne ich skutki uboczne, m.in. zaburzenia gastroenterologiczne. Prezentujemy przypadki kliniczne dwóch pacjentów z ostrą białaczką limfoblastyczną, leczonych w Klinice Hematologii, Onkologii i Transplantologii Dziecięcej w Lublinie, u których powikłaniem chemioterapii była perforacja jelit. W obydwu przypadkach w trakcie leczenia indukcyjnego wystąpiły silne bóle brzucha. W badaniu fizykalnym stwierdzono wzdęcie brzucha, brak perystaltyki, wypuk bębenkowy, a w wykonanym zdjęciu radiologicznym jamy brzusznej cechy niedrożności oraz perforacji jelit. W trybie pilnym wykonano zabieg chirurgiczny. Zarówno operacja, jak i czas rekonwalescencji były przyczyną długich przerw w chemioterapii, co mogło wpływać na rokowanie. Dotychczas nie zostały opracowane algorytmy dotyczące postępowania w przypadku perforacji u pediatrycznych pacjentów onkologicznych. Szeroko rozumiana profilaktyka stanowi niekwestionowaną rolę w zapobieganiu działaniom niepożądanym leków

Serological surveillance reveals patterns of exposure to H5 and H7 influenza A viruses in European poultry

Influenza A viruses of H5 and H7 subtype in poultry can circulate subclinically, and subsequently mutate from low to high pathogenicity with potentially devastating economic and welfare consequences. European Union Member States undertake surveillance of commercial and backyard poultry for early detection and control of subclinical H5 and H7 influenza A infection. This surveillance has moved towards a risk‐based sampling approach in recent years; however quantitative measures of relative risk associated with risk factors utilised in this approach are necessary for optimisation. This study describes serosurveillance for H5 and H7 influenza A in domestic and commercial poultry undertaken in the European Union from 2004 to 2010, where a random sampling and thus representative approach to serosurveillance was undertaken. Using these representative data, this study measured relative risk of seropositivity across poultry categories and spatially across the EU. Data were analysed using multivariable logistic regression. Domestic waterfowl, game birds, fattening turkeys, ratites, backyard poultry and the “other” poultry category holdings had relatively increased probability of H5 and/or H7 influenza A seropositivity, compared to laying‐hen holdings. Amongst laying‐hen holdings, free‐range rearing was associated with increased probability of H7 seropositivity. Spatial analyses detected ‘hotspots’ for H5 influenza A seropositivity in western France and England, and H7 influenza A seropositivity in Italy and Belgium, which may be explained by the demographics and distribution of poultry categories. Findings suggest certain poultry category holdings are at increased risk of subclinical H5 and/or H7 influenza A circulation, and free‐range rearing increases the likelihood of exposure to H7 influenza A. These findings may be used in further refining risk‐based surveillance strategies, and prioritising management strategies in influenza A outbreaks

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review

Background Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses. To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review. Methods We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers. Results Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool. Conclusion There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect

Structure and photophysics of indigoids for singlet fission: Cibalackrot

We report an investigation of structure and photophysics of thin layers of cibalackrot, a sturdy dye derived from indigo by double annulation at the central double bond. Evaporated layers contain up to three phases, two crystalline and one amorphous. Relative amounts of all three have been determined by a combination of X-ray diffraction and FT-IR reflectance spectroscopy. Initially, excited singlet state rapidly produces a high yield of a transient intermediate whose spectral properties are compatible with charge-transfer nature. This intermediate more slowly converts to a significant yield of triplet, which, however, does not exceed 100% and may well be produced by intersystem crossing rather than singlet fission. The yields were determined by transient absorption spectroscopy and corrected for effects of partial sample alignment by a simple generally applicable procedure. Formation of excimers was also observed. In order to obtain guidance for improving molecular packing by a minor structural modification, calculations by a simplified frontier orbital method were used to find all local maxima of singlet fission rate as a function of geometry of a molecular pair. The method was tested at 48 maxima by comparison with the ab initio Frenkel-Davydov exciton model. Published under license by AIP Publishing

Associations between fruit and vegetable intake, leisure-time physical activity, sitting time and self-rated health among older adults : cross-sectional data from the WELL study

BackgroundLifestyle behaviours, such as healthy diet, physical activity and sedentary behaviour, are key elements of healthy ageing and important modifiable risk factors in the prevention of chronic diseases. Little is known about the relationship between these behaviours in older adults. The purpose of this study was to explore the relationship between fruit and vegetable (F&V) intake, leisure-time physical activity (LTPA) and sitting time (ST), and their association with self-rated health in older adults.MethodsThis cross-sectional study comprised 3,644 older adults (48% men) aged 55-65 years, who participated in the Wellbeing, Eating and Exercise for a Long Life ("WELL") study. Respondents completed a postal survey about their health and their eating and physical activity behaviours in 2010 (38% response rate). Spearman\u27s coefficient (rho) was used to evaluate the relationship between F&V intake, LTPA and ST. Their individual and shared associations with self-rated health were examined using ordinal logistic regression models, stratified by sex and adjusted for confounders (BMI, smoking, long-term illness and socio-demographic characteristics).ResultsThe correlations between F&V intake, LTPA and ST were low. F&V intake and LTPA were positively associated with self-rated health. Each additional serving of F&V or MET-hour of LTPA were associated with approximately 10% higher likelihood of reporting health as good or better among women and men. The association between ST and self-rated health was not significant in the multivariate analysis. A significant interaction was found (ST*F&V intake). The effect of F&V intake on self-rated health increased with increasing ST in women, whereas the effect decreased with increasing ST in men.ConclusionThis study contributes to the scarce literature related to lifestyle behaviours and their association with health indicators among older adults. The findings suggest that a modest increase in F&V intake, or LTPA could have a marked effect on the health of older adults. Further research is needed to fully understand the correlates and determinants of lifestyle behaviours, particularly sitting time, in this age group

A new computational method to split large biochemical networks into coherent subnets

<p>Abstract</p> <p>Background</p> <p>Compared to more general networks, biochemical networks have some special features: while generally sparse, there are a small number of highly connected metabolite nodes; and metabolite nodes can also be divided into two classes: internal nodes with associated mass balance constraints and external ones without. Based on these features, reclassifying selected internal nodes (separators) to external ones can be used to divide a large complex metabolic network into simpler subnetworks. Selection of separators based on node connectivity is commonly used but affords little detailed control and tends to produce excessive fragmentation.</p> <p>The method proposed here (Netsplitter) allows the user to control separator selection. It combines local connection degree partitioning with global connectivity derived from random walks on the network, to produce a more even distribution of subnetwork sizes. Partitioning is performed progressively and the interactive visual matrix presentation used allows the user considerable control over the process, while incorporating special strategies to maintain the network integrity and minimise the information loss due to partitioning.</p> <p>Results</p> <p>Partitioning of a genome scale network of 1348 metabolites and 1468 reactions for <it>Arabidopsis thaliana </it>encapsulates 66% of the network into 10 medium sized subnets. Applied to the flavonoid subnetwork extracted in this way, it is shown that Netsplitter separates this naturally into four subnets with recognisable functionality, namely synthesis of lignin precursors, flavonoids, coumarin and benzenoids. A quantitative quality measure called <it>efficacy </it>is constructed and shows that the new method gives improved partitioning for several metabolic networks, including bacterial, plant and mammal species.</p> <p>Conclusions</p> <p>For the examples studied the Netsplitter method is a considerable improvement on the performance of connection degree partitioning, giving a better balance of subnet sizes with the removal of fewer mass balance constraints. In addition, the user can interactively control which metabolite nodes are selected for cutting and when to stop further partitioning as the desired granularity has been reached. Finally, the blocking transformation at the heart of the procedure provides a powerful visual display of network structure that may be useful for its exploration independent of whether partitioning is required.</p

Host-microbe-drug-nutrient screen identifies bacterial effectors of metformin therapy

Metformin is the first-line therapy for treating type-2 diabetes and a promising anti-aging drug. We set out to address the fundamental question of how gut microbes and nutrition, key regulators of host physiology, impact the effects of metformin. Combining two tractable genetic models, the bacterium E. coli and the nematode C. elegans, we developed a high-throughput four-way screen to define the underlying host-microbe-drug-nutrient interactions. We show that microbes integrate cues from metformin and the diet through the phosphotransferase signalling pathway that converges on the transcriptional regulator Crp. A detailed experimental characterization of metformin effects downstream of Crp in combination with metabolic modelling of the microbiota in metformin-treated type-2 diabetic patients predicts the production of microbial agmatine, a regulator of metformin effects on host lipid metabolism and lifespan. Our high-throughput screening platform paves the way for identifying exploitable drug-nutrient-microbiome interactions to improve host health and longevity through targeted microbiome therapie