Sartorius muscle metastases from urothelial cell carcinoma

Urothelial carcinoma of the bladder represents the majority of malignant bladder tumors. Metastases to skeletal muscle from carcinoma of the bladder are extremely rare and are tend to be found in people with advanced-stage carcinoma. In this article we present a man with an unusual metastasis to the left sartorius muscle from an urothelial cell carcinoma, who was submitted in surgery and then in concomitant chemotherapy and external radiation therapy as palliative therap

The effectiveness of a stress-management intervention program in the management of overweight and obesity in childhood and adolescence

Background: Obesity in childhood and adolescence represents a major health problem of our century, and accounts for a significant increase in morbidity and mortality in adulthood. In addition to the increased consumption of calories and lack of exercise, accumulating evidence suggests that childhood obesity is strongly associated with prolonged and excessive activation of the stress system. Aim: The aim of our study was to assess the effectiveness of a stress-management intervention program, which included progressive muscle relaxation, diaphragmatic breathing, guided imagery and cognitive restructuring, in overweight and obese children and adolescents. Methods: Forty-nine children and adolescents (mean age ± SEM: 11.15 ± 1.48 years) were prospectively recruited to participate in this randomized controlled study. Of those, 23 participants were assigned into the intervention group, while 26 participants represented the control group. Anthropometric measurements were recorded at the beginning and at the end of the study, and participants were asked to complete the Screen for Child Anxiety Related Disorders (S.C.A.R.E.D.), the Child Depression Inventory (C.D.I.), the Child Behavior Checklist (C.B.C.L.) and the Youth Self Report (Y.S.R.). Results: The applied stress-management methods resulted in a significant reduction in the body mass index (BMI) in the intervention group compared with the control group [ΔBMI=1.18 vs 0.10 kg/m2 (p˂0.001)]. In addition to BMI, these methods ameliorated depression and anxiety, and reduced the internalizing and externalizing problems in the intervention group. Conclusions: Our study demonstrated that the application of an 8-week stress management program could facilitate weight loss in Greek overweight and obese children and adolescents. Further larger studies are required to evaluate the effectiveness of stress-management methods in overweight and obese subjects

Εφαρμογή και αξιολόγηση της αποτελεσματικότητας ενός προγράμματος εξάσκησης των επιτελικών λειτουργιών σε παιδιά σχολικής ηλικίας με ΔΕΠΥ, ΔΑΦ και ΔΕΠΥ+ΔΑΦ

Εισαγωγή: Τα παιδιά με Διαταραχή Αυτιστικού Φάσματος (ΔΑΦ) και Διαταραχή Ελλειμματικής Προσοχής Υπερκινητικότητας (ΔΕΠΥ) συχνά εμφανίζουν ελλείμματα στην εκτελεστική τους λειτουργικότητα. Τα προγράμματα παρέμβασης που αποσκοπούν στην αποκατάσταση της εκτελεστικής δυσλειτουργίας φαίνεται ότι είναι βοηθητικά σε παιδιά με νευροαναπτυξιακές διαταραχές. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση της καταλληλότητας του προγράμματος εξάσκησης επιτελικών λειτουργιών “EF-TRAIN” σε παιδιά με ΔΑΦ, η αξιολόγηση της αποτελεσματικότητάς του στη ΔΑΦ έναντι της ΔΕΠΥ, αλλά και η εξέταση της επίδρασης της ύπαρξης συμπτωμάτων ΔΕΠΥ στη ΔΑΦ, αναφορικά με την αποτελεσματικότητα του προγράμματος. Μεθοδολογία: 51 παιδιά, 27 με ΔΕΠΥ (20 αγόρια, 7 κορίτσια) και 24 με ΔΑΦ (20 αγόρια, 4 κορίτσια), ηλικίας 5-8 ετών, παρακολούθησαν 20 εβδομαδιαίες συνεδρίες διάρκειας 45 λεπτών του προγράμματος εξάσκησης επιτελικών λειτουργιών “EF-TRAIN”. Οι μετρήσεις που διεξήχθησαν πριν και μετά την παρέμβαση περιελάμβαναν τη χορήγηση νευροψυχολογικών δοκιμασιών και συγκεκριμένα, τη Δοκιμασία «Πύργος» του ΑξΕΛ (αξιολόγηση σχεδιασμού), τη Δοκιμασία «Παρατεταμένης Ακουστικής Προσοχής» του ΑΣυΠ (αξιολόγηση ακουστικής προσοχής), τη Δοκιμασία «Raven Colored Progressive Matrices-Raven CPM» (αξιολόγηση ρέουσας νοημοσύνης), τη Δοκιμασία «Μάγοι & Δράκοι» (αξιολόγηση οπτικής προσοχής και ταχύτητας επεξεργασίας), και τη Δοκιμασία «Μνήμη Αριθμών» (αξιολόγηση μνήμης εργασίας», καθώς επίσης και κλίμακες που συμπληρώθηκαν από τους γονείς και αφορούσαν την ιδιοσυγκρασία του παιδιού (CBQ), τα συναισθηματικά και συμπεριφορικά προβλήματα (SDQ) και το γονεϊκό στρες. Αποτελέσματα: Οι επιτελικές λειτουργίες βελτιώθηκαν και στις δύο ομάδες. Η βαθμολογία στην Ευθεία και την Αντίστροφη Επανάληψη στη Μνήμη Αριθμών αυξήθηκαν μόνο στην ομάδα ΔΑΦ (p=0,004, p<0,001), ενώ ο χρόνος ολοκλήρωσης της δοκιμασίας «Μάγοι & Δράκοι» μειώθηκε σημαντικά επίσης μόνο στην ομάδα ΔΑΦ (p=0,001). Επιπλέον, ο βαθμός αλλαγής στη δοκιμασία Raven CPM, αλλά και στη Συνολική Βαθμολογία και στην Αντίστροφη Επανάληψη στη Μνήμη Αριθμών ήταν μεγαλύτερος για την ομάδα ΔΑΦ (p=0,042, p=0,032, p=0,017). Στο ερωτηματολόγιο SDQ, η βαθμολογία στην υποκλίμακα «Υπερκινητικότητα-Διάσπαση Προσοχής» μειώθηκε σημαντικά μόνο στην ομάδα ΔΑΦ (p=0,049). Η συνολική βαθμολογία στην κλίμακα γονεϊκού στρες μειώθηκε, τόσο στην ομάδα ΔΑΦ, όσο και στην ομάδα ΔΕΠΥ (p=0,011 για ΔΑΦ, p=0,007 για ΔΕΠΥ).Τέλος, στο ερωτηματολόγιο CBQ, η βαθμολογία στις υποκλίμακες «Ανασταλτικός Έλεγχος», «Συναισθηματική Αυτορρύθμιση», «Συγκέντρωση και Γνωστικός Έλεγχος» αυξήθηκε μόνο στην ομάδα ΔΑΦ (p=0,047, p=0,047, p=0,038). Αντίθετα, η βαθμολογία στις υποκλίμακες «Κοινωνική Αντιδραστικότητα» και «Μη Ανοχή στη Ματαίωση» μειώθηκε μόνο στα παιδιά με ΔΕΠΥ (p=0,020, p=0,013). Η βαθμολογία στην κλίμακα DuPaul δεν επηρέασε σημαντικά τη βελτίωση των παιδιών με ΔΑΦ μετά το τέλος του προγράμματος παρέμβασης. Συζήτηση: Το πρόγραμμα EF-TRAIN είναι ένα πρόγραμμα που στοχεύει άμεσα στην εξάσκηση των επιτελικών λειτουργιών και είναι κατάλληλο για παιδιά με ΔΑΦ. Τα παιδιά με ΔΑΦ ωφελήθηκαν περισσότερο από το πρόγραμμα συγκριτικά με τα παιδιά με ΔΕΠΥ, ενώ η ύπαρξη συμπτωμάτων ΔΕΠΥ στη ΔΑΦ δεν επέδρασε σημαντικά, αναφορικά με την αποτελεσματικότητα.Background: Children with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) often present deficits in executive functioning. Intervention programs targeting at the remediation of executive dysfunction seem to be beneficial to children with neurodevelopmental disorders. The aim of the present study was to test the feasibility of the EF-TRAIN program in ASD, to examine the EF-TRAIN’s effectiveness in ASD versus ADHD and to estimate possible effects of ADHD symptoms in ASD regarding the response of ASD participants to the program. Method: Fifty one (51) children, 27 with ADHD (20 boys, 7 girls) and 24 with ASD (20 boys, 4 girls), aged 5-8 years, received 20 weekly 45-minutes sessions of the EF-TRAIN program. Pre-post measurements were conducted and included neuropsychological tests, such as the Tower Task (planning), the Go no Go Task (auditory attention), the Cancellation Task (visual attention and processing speed), the Digit Span Task (working memory) and the Raven Task (fluid intelligence), as well as parental reports regarding child temperament (CBQ), parenting stress (PSI) and emotional-behavioral problems (SDQ). Results: Executive functions were improved in both groups. Digit Span forward and Digit Span backward scores were increased only in the ASD group (p=0,004; p<0,001), whereas the time completion in the cancellation task was also significantly decreased only in the ASD group (p=0,001). The degree of change for the Raven’s total score, the Digit Span raw score and the Digit Span backward was greater in the ASD group (p=0,042;p=0,032;p=0,017). In the SDQ, the score on “Hyperactivity-Inattention” subscale was significantly decreased only in the ASD group (p=0,049). The total parenting stress was reduced for both groups (p=0,007 for ADHD; p=0,011 for ASD). In the CBQ, inhibitory control, emotional self-regulation, attentional focusing-cognitive control were increased only in the ASD group (p=0,047;p=0,047;p=0,038), while social reactivity and frustration intolerance were decreased only in children with ADHD (p=0,020;p=0,013). Scores in all subscales of the DuPaul questionnaire did not affect the overall improvement of children with ASD after the end of the intervention. Conclusions: The EF-TRAIN program is a direct executive functions intervention suitable for children with ASD. Children with ASD benefited more compared to children with ADHD, while the co-occurrence of ADHD symptoms did not affect the cognitive and behavioral gains in ASD children

Heart Score Estimation by Specialized Nurses in a Greek Urban Population

Aims: Specialized nurses estimated the HeartScore in an urban Greek population by recognizing cardiovascular disease (CVD) risk factors in the setting of the Onassis Cardiovascular Prevention Program (OCPP). They also provided nursing consultation and assessed the clinical and biochemical characteristics of the studied population. Methods and Results: Individuals were recruited through TV announcements and via the website of the Onassis Cardiac Surgery Centre. All participants visited the Onassis Cardiac Centre from 20 September to 30 October 2011. Overall, 2,145 individuals were included in the study. CVD risk was calculated by the HeartScore and serum total cholesterol was measured (mean: 193 +/- 43 mg/dl). Although 33% of the participants reported dyslipidaemia, only 17% were on hypolipidaemic treatment. Hypertension and dyslipidaemia frequency increased with age. Conclusion: In the present study, specialized nurses estimated the HeartScore in a Greek urban population. The majority of the studied population was undiagnosed and untreated. These results highlight the necessity for both primary and secondary prevention programs that can be carried out by specialized nurses. Such programs may improve the diagnosis and treatment of CVD risk factors; early initiation and optimization of therapy as well as management of drug intolerance (e.g. statins) can contribute to CVD risk reduction

Clinical feasibility of NGS liquid biopsy analysis in NSCLC patients.

BackgroundAnalysis of circulating tumor nucleic acids in plasma of Non-Small Cell Lung Cancer (NSCLC) patients is the most widespread and documented form of "liquid biopsy" and provides real-time information on the molecular profile of the tumor without an invasive tissue biopsy.MethodsLiquid biopsy analysis was requested by the referral physician in 121 NSCLC patients at diagnosis and was performed using a sensitive Next Generation Sequencing assay. Additionally, a comparative analysis of NSCLC patients at relapse following EGFR Tyrosine Kinase Inhibitor (TKIs) treatment was performed in 50 patients by both the cobas and NGS platforms.ResultsAt least one mutation was identified in almost 49% of the cases by the NGS approach in NSCLC patients analyzed at diagnosis. In 36 cases with paired tissue available a high concordance of 86.11% was observed for clinically relevant mutations, with a Positive Predictive Value (PPV) of 88.89%. Furthermore, a concordance rate of 82% between cobas and the NGS approach for the EGFR sensitizing mutations (in exons 18, 19, 21) was observed in patients with acquired resistance to EGFR TKIs, while this concordance was 94% for the p.T790M mutation, with NGS being able to detect this mutation in three 3 additional patients.ConclusionsThis study indicates the feasibility of circulating tumor nucleic acids (ctNA) analysis as a tumor biopsy surrogate in clinical practice for NSCLC personalized treatment decision making. The use of new sensitive NGS techniques can reliably detect tumor-derived mutations in liquid biopsy and provide clinically relevant information both before and after targeted treatment in patients with NSCLC. Thus, it could aid physicians in treatment decision making in clinical practice

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)