Pre-operative Arterial Embolization of Symptomatic Giant Hemangioma of the Liver

Abstract: The cavernous hemangiomas of the liver are usually small sized and asymptomatic. Most of them are incidentally diagnosed and a very small portion requires therapy. Giant hemangioma can be symptomatic, and this condition is the indication for treatment. The striking complication of surgical treatment of cavernous hemangiomas is intra-operative bleeding. In this case, we aimed to demonstrate that the risk of intraoperative bleeding can be eliminated with the preoperative percutaneous trans-catheter arterial embolization technique

Acquisition and maintenance of excellence:the challenges faced by Dutch top-level gymnasts throughout different stages of athletic development

The purpose of the present study is to identify the within-career challenges top-level gymnasts experience during the initiation, development and mastery stage of athletic development in training sessions, competition, and in daily life. In-depth interviews are used to explore the perceived challenges of 16 talented and elite gymnasts (M = 16.5 years, SD = 4.6 years). Participants are divided into three groups, according to the stage of their athletic development. Several challenges are perceived in all stages of athletic development (e.g. learning new elements, dealing with stress under pressure, dealing with distractions and managing their dual career). As the number of different challenges increases as the gymnasts reach the mastery stage, challenges seem to become more personal and specific than in previous stages. The study shows obvious differences in the nature of the perceived challenges for different stages of athletic development, which provides useful insights for those who work with talented and elite athletes

Considering embodied energy and carbon in heritage buildings – a review

Approximately 20% of UK buildings can be defined as ‘heritage buildings’, offering unique values that should be preserved. They tend to use more energy than newer buildings, creating a strong case for energy retrofits to reduce energy use, greenhouse gas emissions, and improve thermal comfort. However, few studies of heritage retrofits examine embodied impacts, which are the energy and carbon impacts required to manufacture, transport and construct materials and components. This study considers the whole life (embodied plus operational) impacts of retrofitting heritage buildings, through a systematic literature review and thematic analysis. It concludes that; both embodied and operational impacts should be considered in retrofitting projects, retrofitting is better than demolish and rebuild in lifecycle terms, there is a lack of policy mandating for the measurement of lifecycle impacts and low impact retrofitting can be better for conserving heritage values and reducing embodied carbon

Elaia, Pergamon's maritime satellite:The rise and fall of an ancient harbour city shaped by shoreline migration

Throughout human history, communication and trade have been key to society. Because maritime trade facilitated the rapid transportation of passengers and freight at relatively low cost, harbours became hubs for traffic, trade and exchange. This general statement holds true for the Pergamenian kingdom, which ruled wide parts of today's western Turkey during Hellenistic times. Its harbour, located at the city of Elaia on the eastern Aegean shore, was used extensively for commercial and military purposes. This study reconstructs the coastal evolution in and around the ancient harbour of Elaia and compares the observed environmental modifications with archaeological and historical findings. We use micropalaeontological, sedimentological and geochemical proxies to reconstruct the palaeoenvironmental dynamics and evolution of the ancient harbour. The geoarchaeological results confirm the archaeological and historical evidence for Elaia's primacy during Hellenistic and early Roman times, and the city's gradual decline during the late Roman period. Furthermore, our study demonstrates that Elaia holds a unique position as a harbour city during ancient times in the eastern Aegean region, because it was not greatly influenced by the high sediment supply associated with river deltas. Consequently, no dredging of the harbour basins is documented, creating exceptional geo-bioarchives for palaeoenvironmental reconstructions

ABORDAGENS DIAGNÓSTICAS E TERAPÊUTICAS NA DEPRESSÃO EM PACIENTES COM IDADE GERIÁTRICA - UMA REVISÃO BIBLIOGRÁFICA

Introduction: Depression in the elderly is a prevalent and complex condition that significantly affects the quality of life of this population. Its diagnostic assessment is challenging due to its clinical complexity, requiring a comprehensive approach that incorporates validated screening instruments and a thorough clinical evaluation. As for therapeutic options, a multifaceted approach is required, integrating pharmacological and non-pharmacological interventions. Objective: To understand the diagnostic and therapeutic approaches to depression in elderly patients, with a view to improving their quality of life and well-being. Methods: A literature review was carried out using a systematic search of scientific literature published in the last 15 years.  Results and Discussion: Depression in the elderly has a considerable prevalence and is associated with various risk factors and triggers. Early and accurate diagnosis is crucial, as is the adoption of multidisciplinary therapeutic approaches. Pharmacological and non-pharmacological interventions play important roles in the management of geriatric depression, highlighting the importance of primary care and the promotion of positive mental health. Conclusion: Understanding and adequately addressing depression in the elderly requires a holistic and integrated view, taking into account diagnostic challenges, therapeutic options and barriers to accessing mental health care. Prevention and mental health promotion strategies are essential to reduce the impact of depression and improve quality of life in this population.Introducción: La depresión en los ancianos es una enfermedad prevalente y compleja que afecta significativamente a la calidad de vida de esta población. Su evaluación diagnóstica supone un reto debido a su complejidad clínica, requiriendo un abordaje integral que incorpore instrumentos de cribado validados y una evaluación clínica exhaustiva. En cuanto a las opciones terapéuticas, se requiere un enfoque multifacético que integre intervenciones farmacológicas y no farmacológicas. Objetivo: Conocer las aproximaciones diagnósticas y terapéuticas de la depresión en pacientes ancianos, con vistas a mejorar su calidad de vida y bienestar. Métodos: Se realizó una revisión bibliográfica mediante una búsqueda sistemática de la literatura científica publicada en los últimos 15 años.  Resultados y Discusión: La depresión en los ancianos tiene una prevalencia considerable y se asocia a diversos factores de riesgo y desencadenantes. El diagnóstico precoz y preciso es crucial, así como la adopción de enfoques terapéuticos multidisciplinares. Las intervenciones farmacológicas y no farmacológicas desempeñan un papel importante en el tratamiento de la depresión geriátrica, lo que pone de relieve la importancia de la atención primaria y la promoción de una salud mental positiva. Conclusión: Comprender y abordar adecuadamente la depresión en los ancianos requiere una visión holística e integrada, que tenga en cuenta los retos diagnósticos, las opciones terapéuticas y las barreras de acceso a la atención de salud mental. Las estrategias de prevención y promoción de la salud mental son esenciales para reducir el impacto de la depresión y mejorar la calidad de vida en esta población.A depressão em idosos é uma condição prevalente e complexa que afeta significativamente a qualidade de vida dessa população. Sua avaliação diagnóstica é desafiadora devido à complexidade clínica, exigindo uma abordagem abrangente que incorpore instrumentos de triagem validados e uma avaliação clínica minuciosa. Quanto às opções terapêuticas, uma abordagem multifacetada é necessária, integrando intervenções farmacológicas e não farmacológicas. Objetivo: Compreender as abordagens diagnósticas e terapêuticas na depressão em pacientes idosos, visando melhorar a qualidade de vida e o bem-estar desses pacientes. Métodos: Uma revisão bibliográfica foi realizada por meio de uma busca sistemática na literatura científica publicada nos últimos 15 anos. Resultados e Discussão: A depressão em idosos apresenta uma prevalência considerável e está associada a diversos fatores de risco e desencadeadores. O diagnóstico precoce e preciso é crucial, assim como a adoção de abordagens terapêuticas multidisciplinares. Intervenções farmacológicas e não farmacológicas desempenham papéis importantes no manejo da depressão geriátrica, destacando-se a importância da atenção primária e da promoção da saúde mental positiva. Conclusão: Compreender e abordar adequadamente a depressão em idosos requer uma visão holística e integrada, considerando os desafios diagnósticos, as opções terapêuticas e as barreiras de acesso aos cuidados de saúde mental. Estratégias de prevenção e promoção da saúde mental são essenciais para reduzir o impacto da depressão e melhorar a qualidade de vida nessa população.Introdução: A depressão em idosos é uma condição prevalente e complexa que afeta significativamente a qualidade de vida dessa população. Sua avaliação diagnóstica é desafiadora devido à complexidade clínica, exigindo uma abordagem abrangente que incorpore instrumentos de triagem validados e uma avaliação clínica minuciosa. Quanto às opções terapêuticas, uma abordagem multifacetada é necessária, integrando intervenções farmacológicas e não farmacológicas. Objetivo: Compreender as abordagens diagnósticas e terapêuticas na depressão em pacientes idosos, visando melhorar a qualidade de vida e o bem-estar desses pacientes. Métodos: Uma revisão bibliográfica foi realizada por meio de uma busca sistemática na literatura científica publicada nos últimos 15 anos. Resultados e Discussão: A depressão em idosos apresenta uma prevalência considerável e está associada a diversos fatores de risco e desencadeadores. O diagnóstico precoce e preciso é crucial, assim como a adoção de abordagens terapêuticas multidisciplinares. Intervenções farmacológicas e não farmacológicas desempenham papéis importantes no manejo da depressão geriátrica, destacando-se a importância da atenção primária e da promoção da saúde mental positiva. Conclusão: Compreender e abordar adequadamente a depressão em idosos requer uma visão holística e integrada, considerando os desafios diagnósticos, as opções terapêuticas e as barreiras de acesso aos cuidados de saúde mental. Estratégias de prevenção e promoção da saúde mental são essenciais para reduzir o impacto da depressão e melhorar a qualidade de vida nessa população

Haematological and Biochemical Reference Values for Healthy Adults in the Middle Belt of Ghana

BACKGROUND: Reference values are very important in clinical management of patients, screening participants for enrollment into clinical trials and for monitoring the onset of adverse events during these trials. The aim of this was to establish gender-specific haematological and biochemical reference values for healthy adults in the central part of Ghana. METHODS: A total of 691 adults between 18 and 59 years resident in the Kintampo North Municipality and South District in the central part of Ghana were randomly selected using the Kintampo Health and Demographic Surveillance System and enrolled in this cross-sectional survey. Out of these, 625 adults made up of 316 males and 309 females were assessed by a clinician to be healthy. Median values and nonparametric 95% reference values for 16 haematology and 22 biochemistry parameters were determined for this population based on the Clinical Laboratory and Standards Institute guidelines. Values established in this study were compared with the Caucasian values being used currently by our laboratory as reference values and also with data from other African and western countries. RESULTS: REFERENCE VALUES ESTABLISHED INCLUDE: haemoglobin 113-164 g/L for males and 88-144 g/L for females; total white blood cell count 3.4-9.2 × 10(9)/L; platelet count 88-352 × 10(9)/L for males and 89-403 × 10(9)/L for females; alanine aminotransferase 8-54 U/L for males and 6-51 U/L for females; creatinine 56-119 µmol/L for males and 53-106 µmol/L for females. Using the haematological reference values based on the package inserts would have screened out up to 53% of potential trial participants and up to 25% of the population using the biochemical parameters. CONCLUSION: We have established a panel of locally relevant reference parameters for commonly used haematological and biochemical tests. This is important as it will help in the interpretation of laboratory results both for clinical management of patients and safety monitoring during a trial

Age-related changes in relative expression stability of commonly used housekeeping genes in selected porcine tissues

<p>Abstract</p> <p>Background</p> <p>Gene expression analysis using real-time RT-PCR (qRT-PCR) is increasingly important in biological research due to the high-throughput and accuracy of qRT-PCR. For accurate and reliable gene expression analysis, normalization of gene expression data against housekeeping genes or internal control genes is required. The stability of reference genes has a tremendous effect on the results of relative quantification of gene expression by qRT-PCR. The expression stability of reference genes could vary according to tissues, age of individuals and experimental conditions. In the pig however, very little information is available on the expression stability of reference genes. The aim of this research was therefore to develop a new set of reference genes which can be used for normalization of mRNA expression data of genes expressed in varieties of porcine tissues at different ages.</p> <p>Results</p> <p>The mRNA expression stability of nine commonly used reference genes (<it>B2M, BLM, GAPDH, HPRT1, PPIA, RPL4, SDHA, TBP </it>and <it>YWHAZ</it>) was determined in varieties of tissues collected from newborn, young and adult pigs. geNorm, NormFinder and BestKeeper software were used to rank the genes according to their stability. geNorm software revealed that <it>RPL4, PPIA </it>and <it>YWHAZ </it>showed high stability in newborn and adult pigs, while <it>B2M, YWHAZ </it>and <it>SDHA </it>showed high stability in young pigs. In all cases, <it>GAPDH </it>showed the least stability in geNorm. NormFinder revealed that <it>TBP </it>was the most stable gene in newborn and young pigs, while <it>PPIA </it>was most stable in adult pigs. Moreover, geNorm software suggested that the geometric mean of three most stable gene would be the suitable combination for accurate normalization of gene expression study.</p> <p>Conclusions</p> <p>Although, there was discrepancy in the ranking order of reference genes obtained by different analysing software methods, the geometric mean of the <it>RPL4, PPIA </it>and <it>YWHAZ </it>seems to be the most appropriate combination of housekeeping genes for accurate normalization of gene expression data in different porcine tissues at different ages.</p

Randomized Controlled Trial of RTS,S/AS02D and RTS,S/AS01E Malaria Candidate Vaccines Given According to Different Schedules in Ghanaian Children

Background:The target delivery channel of RTS,S candidate malaria vaccines in malaria-endemic countries in Africa is the World Health Organisation Expanded Program on Immunization. As an Adjuvant System, age de-escalation and schedule selection step, this study assessed 3 schedules of RTS,S/AS01E and RTS,S/AS02D in infants and young children 5&ndash;17 months of age in Ghana.Methodology:A Phase II, partially-blind randomized controlled study (blind to vaccine, not to schedule), of 19 months duration was conducted in two (2) centres in Ghana between August 2006 and May 2008. Subjects were allocated randomly (1:1:1:1:1:1) to one of six study groups at each study site, each defining which vaccine should be given and by which schedule (0,1-, 0,1,2- or 0,1,7-months). For the 0,1,2-month schedule participants received RTS,S/AS01E or rabies vaccine at one center and RTS,S/AS01E or RTS,S/AS02D at the other. For the other schedules at both study sites, they received RTS,S/AS01E or RTS,S/AS02D. The primary outcome measure was the occurrence of serious adverse events until 10 months post dose 1.Results:The number of serious adverse events reported across groups was balanced. One child had a simple febrile convulsion, which evolved favourably without sequelae, considered to be related to RTS,S/AS01E vaccination. Low grade reactions occurred slightly more frequently in recipients of RTS,S/AS than rabies vaccines; grade 3 reactions were infrequent. Less local reactogenicity occurred with RTS,S/AS01E than RTS,S/AS02D. Both candidate vaccines were highly immunogenic for anti-circumsporozoite and anti-Hepatitis B Virus surface antigen antibodies. Recipients of RTS,S/AS01E compared to RTS,S/AS02D had higher peak anti-circumsporozoite antibody responses for all 3 schedules. Three dose schedules were more immunogenic than 2 dose schedules. Area under the curve analyses for anti-circumsporozoite antibodies were comparable between the 0,1,2- and 0,1,7-month RTS,S/AS01E schedules.Conclusions:Both candidate malaria vaccines were well tolerated. Anti-circumsporozoite responses were greater with RTS,S/AS01E than RTS,S/AS02D and when 3 rather than 2 doses were given. This study supports the selection of RTS,S/AS01E and a 3 dose schedule for further development in children and infants

Automated detection and segmentation of non-small cell lung cancer computed tomography images.

peer reviewedDetection and segmentation of abnormalities on medical images is highly important for patient management including diagnosis, radiotherapy, response evaluation, as well as for quantitative image research. We present a fully automated pipeline for the detection and volumetric segmentation of non-small cell lung cancer (NSCLC) developed and validated on 1328 thoracic CT scans from 8 institutions. Along with quantitative performance detailed by image slice thickness, tumor size, image interpretation difficulty, and tumor location, we report an in-silico prospective clinical trial, where we show that the proposed method is faster and more reproducible compared to the experts. Moreover, we demonstrate that on average, radiologists & radiation oncologists preferred automatic segmentations in 56% of the cases. Additionally, we evaluate the prognostic power of the automatic contours by applying RECIST criteria and measuring the tumor volumes. Segmentations by our method stratified patients into low and high survival groups with higher significance compared to those methods based on manual contours

T Cell Responses to the RTS,S/AS01E and RTS,S/AS02D Malaria Candidate Vaccines Administered According to Different Schedules to Ghanaian Children

BACKGROUND: The Plasmodium falciparum pre-erythrocytic stage candidate vaccine RTS,S is being developed for protection of young children against malaria in sub-Saharan Africa. RTS,S formulated with the liposome based adjuvant AS01(E) or the oil-in-water based adjuvant AS02(D) induces P. falciparum circumsporozoite (CSP) antigen-specific antibody and T cell responses which have been associated with protection in the experimental malaria challenge model in adults. METHODS: This study was designed to evaluate the safety and immunogenicity induced over a 19 month period by three vaccination schedules (0,1-, 0,1,2- and 0,1,7-month) of RTS,S/AS01(E) and RTS,S/AS02(D) in children aged 5-17 months in two research centers in Ghana. Control Rabies vaccine using the 0,1,2-month schedule was used in one of two study sites. RESULTS: Whole blood antigen stimulation followed by intra-cellular cytokine staining showed RTS,S/AS01(E) induced CSP specific CD4 T cells producing IL-2, TNF-α, and IFN-γ. Higher T cell responses were induced by a 0,1,7-month immunization schedule as compared with a 0,1- or 0,1,2-month schedule. RTS,S/AS01(E) induced higher CD4 T cell responses as compared to RTS,S/AS02(D) when given on a 0,1,7-month schedule. CONCLUSIONS: These findings support further Phase III evaluation of RTS,S/AS01(E). The role of immune effectors and immunization schedules on vaccine protection are currently under evaluation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00360230