Proportion of thick versus thin melanomas as a benchmarking tool

Background: The ratio of benign moles excised for each malignant melanoma diagnosed (number-needed-to-excise (NNE)) is a metric used to express the efficiency of diagnostic accuracy of melanoma. The literature suggests a progressive effort to reduce the NNE, thus raising concerns about missing early melanoma because the NNE does not capture the most significant outcome for melanoma prognosis, which is linked to the Breslow thickness. A lower NNE could reduce health costs related to melanoma diagnosis only if doing so does not increase the proportion of thicker melanomas. Objectives: The diagnostic performance by two tertiary referral centres using the NNE and proportion of thick (Breslow thickness > 1 mm) versus thin (Breslow thickness ≤ 1 mm) excised melanoma (thick/thin ratio: TTR) was compared to determine if a lower NNE is associated with a greater proportion of thicker melanoma. Combining TTR with NNE allows a better estimate of the effectiveness in melanoma diagnosis, assessing both the overall cost for a given pool of excised melanomas and costs due to unnecessary nevi excision at a particular dermatology centre. Methods: Demographic data and Breslow thickness of excised melanoma were extracted from patient histologic records at two referral centres for melanoma (Parma Dermatology Unit and Ravenna and Meldola Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori. IRCCS (IRST)) on all skin tumours excised between 2002 and 2011 and diagnosed as melanoma or melanocytic nevus. NNE and TTR were calculated and compared among the considered variables. Logistic regression was used to assess the contribution of each variable in predicting a higher TTR. Results: Data from 16,738 excised lesions were analysed. The IRST Unit reported a mean NNE of 4.6, whereas the Parma Unit excised 10.6 nevi for each melanoma. No statistically significant differences existed in the mean (IRST Unit, 0.56 ± 0.89 mm; Parma Unit, 1.07 ± 2.2 mm) and median (range) Breslow thickness (IRST Unit, 0.4 (9) mm; Parma Unit 0.4 (30) mm). The TTR between centres was significantly different (Parma Unit, 24%; IRST Unit, 12%; p < 0.001). Based on logistic regression, the diagnosing centre was the most powerful factor in determining a thickness of >1 mm among diagnosed melanomas (OR = 1.8; 95% CI, 1.2–2.7; p < 0.01), with all other factors being equal. The NNE decreased at both centres from younger-to-older patients, whereas the TTR increased simultaneously; however, the increase in TTR was non-significantly related to NNE reduction after adjusting for confounders (age, gender, and localization). Conclusions: A better diagnostic performance is capable of reducing the NNE and TTR, i.e., unnecessary excisions of melanocytic nevi can be reduced without increasing the risk of overlooking melanomas. The TTR, in addition to the NNE, allows stakeholders to better estimate the effectiveness in melanoma diagnosis because both overall costs for a given pool of excised melanomas and costs due for unnecessary nevi excision at a particular dermatology centre can be compared

Reprodução assistida e manejo de ovinos de corte.

Reprodução; Nutrição; Reprodução.bitstream/item/104830/1/Reproducao-assistida-e-manejo.pd

Gait-related frequency modulation of beta oscillatory activity in the subthalamic nucleus of parkinsonian patients

Background: Abnormal beta band activity in the subthalamic nucleus (STN) is known to be exaggerated in patients with Parkinson's disease, and the amplitude of such activity has been associated with akinetic rigid symptoms. New devices for deep brain stimulation (DBS) that operate by adapting the stimulation parameters generally rely on the detection of beta activity amplitude modulations in these patients. Movement-related frequency modulation of beta oscillatory activity has been poorly investigated, despite being an attractive variable for extracting information about basal ganglia activity. Objective: We studied the STN oscillatory activity associated with locomotion and proposed a new approach to extract movement related information from beta band activity. Methods: We recorded bilateral local field potential of the STN in eight parkinsonian patients implanted with DBS electrodes during upright quiet standing and unperturbed walking. Neurophysiological recordings were combined with kinematic measurements and individual molecular brain imaging studies. We then determined the information carried by the STN oscillatory activity about locomotion and we identified task-specific biomarkers. Results: We found a gait-related peak frequency modulation of the beta band of STN recordings of parkinsonian patients. This novel biomarker and the associated power modulations were highly informative to detect the walking state (with respect to standing) in each single patient. Conclusion: Frequency modulation in the human STN represents a fundamental aspect of information processing of locomotion. Our information-driven approach could significantly enrich the spectrum of Parkinson's neural markers, with input signals encoding ongoing tasks execution for an appropriate online tuning of DBS delivery

Dietary Nitrate: Effects on the health of weaning pigs and Antimicrobial activity on seven probiotic Bifidobacterium spp. strains

The potential role of nitrite as an antimicrobial substance in the stomach may be of some importance in the ecology of the gastrointestinal tract and in host physiology. It has been shown that nitrite, under the acidic conditions of the stomach, may kill gut pathogens like Salmonella enteritidis, Escherichia coli, Salmonella typhimurium, and Yersinia enterocolitica, whereas acid alone has only a bacteriostatic effect. An in vivo study was conducted in order to assess the effects of dietary nitrate on microbiota and on the health of the gut (particularly in the stomach and small intestine). 96 weaning pigs were fed a diet containing high nitrate levels (15 mg and 150 mg) and then challenged with Salmonella enterica serovar typhimurium. Differences in composition of the gut microbiota were assessed by analysing samples from the pigs: To date analysis of 48 pigs has been completed.. Preliminary results demonstrated no effect on the population densities of microbial groups either from the challenge or from nitrate intake. However, increasing the time from challenge decreased either the counts of LAB in the stomach and jejunum or of clostridia in the stomach. Bifidobacteria also decreased in the stomach contents as nitrate supplementation increased. Supplementing the feedstuff with high dietary nitrate intake and then challenging with Salmonella did not affect the gastric pH or the degree of ulceration in the pigs. The synergistic bactericidal effects of pH, nitrite and thiocyanate on seven probiotic Bifidobacterium spp. strains were also investigated in an in vitro study. The results of the in vitro study demonstrated that an inhibitory effect exists on the seven probiotic bifidobacteria investigated with an exposure longer than 2 hours and pH values < 5.0. Addition of thiocyanate also increased the susceptibility of the tested strains. In this in vitro study, the most resistant strains at all conditions were B. animalis subsp. lactis Ra 18 and P32 and B. choerinum Su 877, Su 837 and Su 891

Model-based meta-analysis of salbutamol pharmacokinetics and practical implications for doping control.

Salbutamol was included in the prohibited list of the World Anti-Doping Agency (WADA) in 2004. Although systemic intake is banned, inhalation for asthma is permitted but with dosage restrictions. The WADA established a urinary concentration threshold to distinguish accordingly prohibited systemic self-administration from therapeutic prescription by inhalation. This study aimed at evaluating the ability of the WADA threshold to differentiate salbutamol therapeutic use from violation of antidoping rules. Concentration-time profile of salbutamol in plasma and its excretion in urine was characterized through a model-based meta-analysis of individual and aggregate data collected after administration of a large range of doses following different modes of administration and under a variety of conditions. The developed model adequately fitted salbutamol plasma and urine concentration-time profiles of the 13 selected studies. Model-based simulations confirmed that a wide range of salbutamol urine concentrations might be measured after drug intake. Although violation of the WADA Code can be strongly suspected in individuals showing very high salbutamol urine concentrations, uncertainty remains for values close to the WADA threshold as they can be compatible with both permitted therapeutic use and violation. Although not entirely discriminant, the current WADA rule is globally supported by our appraisal. It could be further improved by a slight and reasonable adjustment of inhaled daily dosages allowed for therapeutic use. Our model might help antidoping experts in the evaluation of suspected doping cases through confronting the athlete's urine measurements with their allegations about salbutamol treatment

Commissioning of the electron injector for the AWAKE experiment

The advanced wakefield experiment (AWAKE) at CERN is the first proton beam-driven plasma wakefield acceleration experiment. The main goal of AWAKE RUN 1 was to demonstrate seeded self-modulation (SSM) of the proton beam and electron witness beam acceleration in the plasma wakefield. For the AWAKE experiment, a 10-meter-long Rubidium-vapor cell together with a high-power laser for ionization was used to generate the plasma. The plasma wakefield is driven by a 400 GeV/c proton beam extracted from the super proton synchrotron (SPS), which undergoes a seeded self-modulation process in the plasma. The electron witness beam used to probe the wakefields is generated from an S-band RF photo-cathode gun and then accelerated by a booster structure up to energies between 16 and 20 MeV. The first run of the AWAKE experiment revealed that the maximum energy gain after the plasma cell is 2 GeV, and the SSM mechanism of the proton beam was verified. In this paper, we will present the details of the AWAKE electron injector. A comparison of the measured electron beam parameters, such as beam size, energy, and normalized emittance, with the simulation results was performed

Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study

Background Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. Methods A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women’s preferences: a survey using a tailored questionnaire, and a discrete choice experiment. Results Only 8 and 6 % of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40 % ended their pregnancies by caesarean section in public and private hospitals, respectively. Conclusions The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35 % caesarean sections are unlikely related to their preferences for mode of delivery.Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Liu, Nancy H.. UCSF General Internal Medicine; Estados UnidosFil: Bonotti, Ana María. Ministerio de Salud de la Nación; ArgentinaFil: Izbizky, Gustavo H.. Hospital Italiano; ArgentinaFil: Ferrary, Marta. Hospital Magdalena; ArgentinaFil: Viergue, Nora. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Vigil, Silvia I.. Hospital Británico de Buenos Aires; ArgentinaFil: Zalazar Denett, Gabriela. Hospital Materno Infantil Dr. Carlos Gianantonio; ArgentinaFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Intrasexual vibrational behavior of Philaenus spumarius in semi-field conditions

Insects that communicate by vibrational signals live in a complex interactive network of communication. Most studies on insect intrasexual behavior, based on plant-borne vibrational signals, have targeted few individuals. Despite their importance, behaviors that occur within groups were often overlooked. The study of multiple individuals, when insects occur in high density could simulate the environment in which they live and provide more reliable information on their behavior. In semi-field conditions, we investigated the intrasexual behavior of the meadow spittlebug, Philaenus spumarius. Vibrational signals exchanged among individuals of the same sex were recorded throughout their adult stage, from late spring to early autumn, and during the day, from the morning to the evening using a laser vibrometer. Males were less active than females throughout the season and their interactions were less frequent compared to females. Intrasexual interactions were characterized by signal overlapping in both unisex groups, in addition to signal alternating only in the case of males. In conclusion, the study of signaling behavior in intrasexual groups contributed to a better understanding of P. spumarius social behavior. We discuss the hypothesis of a possible competitive behavior between males and cooperative behavior between female