A case of multiple myeloma presemnting clinically as a solitary tumour of the skull

No Abstrac

Основы теории действий в условиях неопределенности

Цель исследования: рассмотреть теорию непредвиденных обстоятельств, включая взаимосвязь между непредвиденными ситуациями и управленческими показателями, на основе которых можно будет вывести алгоритм действий в условиях неопределенности для каждого предприятия в отдельности (так как не существует универсальных систем, которые можно применять в любой организации)

Sydney Conservatorium of Music Postgraduate Handbook 2009

In stage III breast carcinoma, metastasized disease needs to be determined. In the past, conventional imaging by liver ultrasound, chest X-ray and bone scintigraphy was the work-up of choice. Recently, FDG-PET/CT was found to have additional value, but clinicians are hesitant to introduce this technique. We present three patients in whom FDG-PET/CT was applied. A 61-year-old woman with stage III breast carcinoma after conventional work-up was upstaged to stage IV breast carcinoma by FDG-PET/CT, upon which her treatment was changed. A 55-year-old woman suspected of stage IV breast carcinoma after conventional imaging was downstaged to stage III after FDG-PET/CT. Her treatment was changed as well. In a 78-year-old woman with recurrent breast carcinoma, the diagnostic certainty of stage III breast carcinoma was increased by FDG-PET/CT. We conclude that FDG-PET/CT is valuable for adequately diagnosing metastases in patients with stage III breast carcinoma and can replace conventional imaging

Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy

Background Mindfulness-based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self-compassion and mindfulness. Although rumination and mindfulness after MBCT are associated with relapse, the association of CR, rumination, self-compassion, and mindfulness with relapse before initiation of MBCT has never been investigated. Methods Data were drawn from two randomized controlled trials, including a total of 282 remitted MDD participants (>= 3 depressive episodes) who had been using maintenance antidepressant medication (mADM) for at least 6 months before baseline. All participants were offered MBCT while either their mADM was maintained or discontinued after MBCT. CR, rumination, self-compassion, and mindfulness were assessed at baseline by self-rated questionnaires and were used in Cox proportional hazards regression models to investigate their association with relapse. Results CR and mindfulness were associated with relapse, independent of residual symptoms, previous depressive episodes, and mADM-use. Higher CR and lower mindfulness increased the risk of relapse. Self-compassion was not associated with relapse. For rumination, a significant interaction with mADM-use was found. Rumination was associated with relapse in patients who discontinued their mADM, while this effect was absent if patients continued mADM. Conclusions These results show that CR, rumination, and mindfulness are associated with relapse in remitted MDD-patients before initiation of MBCT, independent of residual symptoms and previous depressive episodes. This information could improve decisions in treatment planning in remitted individuals with a history of depression.Stress-related psychiatric disorders across the life spa

Impaired cellular immune response in rats exposed perinatally to Baltic Sea herring oil or 2,3,7,8-TCDD

While the immunotoxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has been well established, the effects of complex environmental mixtures of polyhalogenated aromatic hydrocarbons (PHAHs) are poorly understood. Many PHAHs, including the polychlorinated-biphenyls (PCBs), -dibenzofurans (PCDFs), and dibenzo-p-dioxins (PCDDs), possess 'dioxin-like' activities, and accumulate in the aquatic food chain. Organisms occupying high trophic levels may therefore be exposed to concentrations which may present an immunotoxic risk. In this study, pregnant PVG rats were administered a daily oral dose of 1 ml of the following during pregnancy and lactation: (1) oil extracted from herring caught in the relatively uncontaminated Atlantic Ocean; (2) oil extracted from herring caught in the contaminated Baltic Sea; or (3) the Atlantic herring oil extract spiked with 2,3,7,8-TCDD. The daily intakes of aryl hydrocarbon (Ah)-receptor dependent toxic equivalents (TEQ) for mothers were 0.3 in the Atlantic group, 2.1 in the Baltic group, and 134 ng/kg body wt. in the 2,3,7,8-TCDD positive control group. Immune function and host resistance to rat cytomegalovirus (RCMV) we

The Dutch multidisciplinary guideline osteoporosis and fracture prevention, taking a local guideline to the international arena

Background: In 2018, a grant was provided for an evidence-based guideline on osteoporosis and fracture prevention based on 10 clinically relevant questions. Methods: A multidisciplinary working group was formed with delegates from Dutch scientific and professional societies, including representatives from the patient’s organization and the Dutch Institute for Medical Knowledge. The purpose was to obtain a broad consensus among all participating societies to facilitate the implementation of the updated guideline. Results: Novel recommendations in our guideline are as follows: - In patients with an indication for DXA of the lumbar spine and hips, there is also an indication for VFA. - Directly starting with anabolic drugs (teriparatide or romosozumab) in patients with a very high fracture risk; - Directly starting with zoledronic acid in patients 75 years and over with a hip fracture (independent of DXA); - Directly starting with parenteral drugs (denosumab, teriparatide, zoledronic acid) in glucocorticoid-induced osteoporosis with very high fracture risk; - A lifelong fracture risk management, including lifestyle, is indicated from the start of the first treatment. Conclusion: In our new multidisciplinary guideline osteoporosis and fracture prevention, we developed 5 “relatively new statements” that are all a crucial step forward in the optimization of diagnosis and treatment for fracture prevention. We also developed 5 flowcharts, and we suppose that this may be helpful for individual doctors and their patients in daily practice and may facilitate implementation.</p

The Dutch multidisciplinary guideline osteoporosis and fracture prevention, taking a local guideline to the international arena

Background: In 2018, a grant was provided for an evidence-based guideline on osteoporosis and fracture prevention based on 10 clinically relevant questions. Methods: A multidisciplinary working group was formed with delegates from Dutch scientific and professional societies, including representatives from the patient’s organization and the Dutch Institute for Medical Knowledge. The purpose was to obtain a broad consensus among all participating societies to facilitate the implementation of the updated guideline. Results: Novel recommendations in our guideline are as follows: - In patients with an indication for DXA of the lumbar spine and hips, there is also an indication for VFA. - Directly starting with anabolic drugs (teriparatide or romosozumab) in patients with a very high fracture risk; - Directly starting with zoledronic acid in patients 75 years and over with a hip fracture (independent of DXA); - Directly starting with parenteral drugs (denosumab, teriparatide, zoledronic acid) in glucocorticoid-induced osteoporosis with very high fracture risk; - A lifelong fracture risk management, including lifestyle, is indicated from the start of the first treatment. Conclusion: In our new multidisciplinary guideline osteoporosis and fracture prevention, we developed 5 “relatively new statements” that are all a crucial step forward in the optimization of diagnosis and treatment for fracture prevention. We also developed 5 flowcharts, and we suppose that this may be helpful for individual doctors and their patients in daily practice and may facilitate implementation.</p

The RESET project: constructing a European tephra lattice for refined synchronisation of environmental and archaeological events during the last c. 100 ka

This paper introduces the aims and scope of the RESET project (. RESponse of humans to abrupt Environmental Transitions), a programme of research funded by the Natural Environment Research Council (UK) between 2008 and 2013; it also provides the context and rationale for papers included in a special volume of Quaternary Science Reviews that report some of the project's findings. RESET examined the chronological and correlation methods employed to establish causal links between the timing of abrupt environmental transitions (AETs) on the one hand, and of human dispersal and development on the other, with a focus on the Middle and Upper Palaeolithic periods. The period of interest is the Last Glacial cycle and the early Holocene (c. 100-8 ka), during which time a number of pronounced AETs occurred. A long-running topic of debate is the degree to which human history in Europe and the Mediterranean region during the Palaeolithic was shaped by these AETs, but this has proved difficult to assess because of poor dating control. In an attempt to move the science forward, RESET examined the potential that tephra isochrons, and in particular non-visible ash layers (cryptotephras), might offer for synchronising palaeo-records with a greater degree of finesse. New tephrostratigraphical data generated by the project augment previously-established tephra frameworks for the region, and underpin a more evolved tephra 'lattice' that links palaeo-records between Greenland, the European mainland, sub-marine sequences in the Mediterranean and North Africa. The paper also outlines the significance of other contributions to this special volume: collectively, these illustrate how the lattice was constructed, how it links with cognate tephra research in Europe and elsewhere, and how the evidence of tephra isochrons is beginning to challenge long-held views about the impacts of environmental change on humans during the Palaeolithic. © 2015 Elsevier Ltd.RESET was funded through Consortium Grants awarded by the Natural Environment Research Council, UK, to a collaborating team drawn from four institutions: Royal Holloway University of London (grant reference NE/E015905/1), the Natural History Museum, London (NE/E015913/1), Oxford University (NE/E015670/1) and the University of Southampton, including the National Oceanography Centre (NE/01531X/1). The authors also wish to record their deep gratitude to four members of the scientific community who formed a consultative advisory panel during the lifetime of the RESET project: Professor Barbara Wohlfarth (Stockholm University), Professor Jørgen Peder Steffensen (Niels Bohr Institute, Copenhagen), Dr. Martin Street (Romisch-Germanisches Zentralmuseum, Neuwied) and Professor Clive Oppenheimer (Cambridge University). They provided excellent advice at key stages of the work, which we greatly valued. We also thank Jenny Kynaston (Geography Department, Royal Holloway) for construction of several of the figures in this paper, and Debbie Barrett (Elsevier) and Colin Murray Wallace (Editor-in-Chief, QSR) for their considerable assistance in the production of this special volume.Peer Reviewe

The continuous debate in literature about the usage of iodine-131 dosing for the ablation of thyroid remnants and metastases.

Item does not contain fulltextRadioiodine plays an important role in the treatment of thyroid cancer. It is used for thyroid remnant ablation as well as for treatment of metastatic disease. Despite the fact that it is used all over the world for these indications, the exact administered dose is still a subject for DISCUSSION: Two methods are widely available: the so-called fixed empiric method and the dosimetric one. This review will highlight the aspects of radioiodine in treatment of thyroid cancer and discuss the advantages and disadvantages of the several methods for the calculation of the administered dose

Bezinken van zand in hopperzuigers

Invloed van turbulentie en korrelverdeling op het bezinkproces. Voor het optimaal beladen van sleephopperzuigers is het belangrijk om inzicht te hebben in de processen die plaats hebben in het beun van een sleephopperzuiger. Een van de deel-processen is het bezinken van zand in een hoog geconcentreerd zandwater mengsel onder invloed van turbulentie. Het doel van dit rapport is om dit bezinkproces in kaart te brengen. Om dit doel te bereiken zijn er proeven uitgevoerd in een proefopstelling waarin bezinkproeven zijn uit te voeren. Gedurende de proeven is de mate van turbulentie in de kolom, de beginconcentratie van het mengsel en gradatie van het zand gevarieerd. Hierdoor is inzicht verkregen in de invloed van beide parameters op het bezinkgedrag van verschillende zandsoorten. Tijdens de proeven worden de concentraties op 12 punten over de hoogte gemeten. Uit deze data is vervolgens een concentratieprofiel over de hoogte bepaald. Tenslotte is er gekeken in hoeverre deze data overeenkomen met het gemaakte computermodel dat dit proces kan simuleren. Uit de proeven in water die dienden om het turbulentieniveau in kaart te brengen kwamen de volgende zaken naar voren: \u95 Uit de proefresultaten is gebleken dat de turbulentie die in de kolom wordt opgewekt redelijk homogeen over de hoogte verdeeld is en in de x- en zrichting van dezelfde orde grootte is. De belangrijkste conclusies, die uit de proeven met de uniforme zandfracties volgen, zijn: \u95 De werkelijke karakteristieke korreldiameter verschilt aanzienlijk van de volgens de leverancier opgegeven karakteristieke korreldiameter. \u95 De verticale turbulente snelheidsintensiteit (Vz;rms) blijkt onafhankelijk van de concentratie te zijn en afhankelijk van het turbulentieinstellingen . \u95 De gemeten valsnelheden verschillen duidelijk van de volgens theorieen berekende valsnelheden. De gecombineerde theorie van Ruby en AIDibouni geeft de beste benadering van de meetresultaten. \u95 De turbulente diffusiecoefficient £: is niet eenvoudig uit de meetdata te berekenen. \u95 Uit het door ons gemaakte model volgt dat de beginconcentratie, de zandsoort en het turbulentieniveau van invloed zijn op de grootte van de turbulente diffusiecoefficient. De proeven met de min of meer natuurlijke zandverdeling maakten het volgende duidelijk: \u95 De valsnelheid van de karakteristieke korrels van het mengsel is ongeveer gelijk aan die van de karakteristieke karrels van een uniforme zandfractie met gelijke karakteristieke korrelgrootte. \u95 Een relatief hoog turbulentieniveau in de kolom heeft tot gevolg dat de ontmenging minder groot zal zijn. Ook leidt een hoger turbulentieniveau tot een tragere ontmenging. \u95 De beginconcentratie is niet van invloed op de mate van ontmenging. Wel leidt een hogere beginconcentratie tot een verlaging van de snelheid waarmee de ontmenging plaatsvindt. De conclusie is dat het beschrijven van het bezinkgedrag van korrels in een hooggeconcentreerd zand-watermengsel wel mogelijk is. Er is echter verdere analyse van de data nadig en er zijn eventueel meer proeven nodig om het verband tussen het turbulentieniveau (uitgedrukt in bijvoorbeeld Vrms) en de turbulente diffusiecoefficient (l» beter te kunnen beschrijven. Het model kan verder verbeterd warden door E niet constant over de hoogte te veronderstellen.Hydraulic EngineeringCivil Engineering and Geoscience