The Importance Of Monoclonal Proteins Determination For The Correct Diagnosis Of Transthyretin Cardiac Amyloidosis By [Tc-99m]Tc-diphosphonates

EPS-066 Aim/Introduction: To analyze the influence of the determination of free monoclonal proteins in blood and urine in the final diagnosis of Transthyretin Cardiac Amyloidosis (TTRA). Materials and Methods: We have analyzed 200 [99mTc]Tc-diphosphonates scans: 192 performed on 190 patients under suspicion of TTRA and 7 patients with grade II-III radiotracer myocardial deposit as a casual finding (November/2013 - January/2020). Likewise, clinical and laboratory characteristics (heart failure, LVEF, proBNP levels, immunofixation in serum and/or urine for the detection of monoclonal chains and chronic renal failure) have been evaluated. A positive case has been considered for TTRAwt or senile (Score Perugini II-III scan, negative immunofixation in serum and/or urine, negative genetic study), positive case for hereditary TTRA (Score Perugini II-III scan, negative immunofixation and positive genetic study), positive case for secondary amyloidosis (positive immunofixation and presence of hematologic malignancy) and undetermined amyloidosis (immunofixation not performed or positive and absence of haematologic malignancies at follow-up). Results: 59 positive scans have been detected, 47 men (79’7%) and 12 women (20’3%). The mean age of the group of positives was 82’66 years, while that of the negatives was 72’15. The mean proBNP levels in the positives are 7561, compared to 5869 in the negative group. Immunofixation (serum and/or urine for detection of kappa or lambda monoclonal chains at 30 (50.8%) has been performed on these patients. Finally, 37.2% (22/59) resulted in ATTRwt, 3.4% (2/59) hereditary ATTR (genetic study: variant E54Q and mutation c.424> A (p.Va.122Ile) in exon 4 of TTR) and 1.7% (1/59) secondary amyloidosis. The remaining 34/59 (57.7%) cases were undetermined amyloidosis (6 positive immunofixation and 27 without monoclonal proteins determination). Conclusion: Determination of monoclonal bands in blood and urine is mandatory to correctly characterize cases of cardiac amyloidosis and, in presence of monoclonal bands, to assess the existence of underlying haematological malignancies

Impact Of Sentinel Lymph Node Biopsy In Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

EPS 196 Aim/Introduction: To analyze how many of the patients undergoing neoadjuvant chemotherapy (NCT) may benefit from SLNB, as well as the impact on patient management, especially in those with early axillary involvement. Materials and Methods: We included patients with breast carcinoma candidates to NCT discussed at the Tumor Committee of our hospital (April/2017-August/2019). All of them were subjected to clinical assessment, ultrasound and, if appropriate, histological analysis, axillary pre and post- NCT. Sentinel lymph node detection was performed after periareolar injection of [99mTc]Tc-nanocoloid (74 MBq) the day before surgery. In some cases, blue dye was injected and/or a pre-NPC metal clip was placed in the affected node. Results: Sixty-two patients were included. NCT achieved a complete breast response in 12 patients, partial in 46 and non-response in 4. Initially, 31 patients were classified as N0 and 31 as N+ (28 N1 and 3 N2), achieving a complete axillary response in 58% of N+ (18). SLNB was performed in 49 patients (79%; 100% in N0 and 58% in N+ from baseline). The gamma detection rate of the sentinel lymph node was 91.8% (93.5% in N0 and 88.9% in N+). 28 lymphadenectomies were undergone (45.2%; 22.5% in N0 and 67.7% in N+), 11 due to positive SLNB (5 N0 and 6 N1), 13 owing to lack of axillary response and 4 caused by the non-localization of the sentinel lymph node. SLNB was performed in 58% of N+ patients, of which 44.4% were negative, avoiding lymphadenectomy. Metal clip and/or blue dye techniques were used in 31 cases (50%). Conclusion: SLNB is viable in a high percentage of patients with previous NCT, with a high detection rate, even in patients with early affected axilla, avoiding lymphadenectomy to patients who achieve a complete response of the axillary lymph node

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining ‘success’ and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members

Experiences of water immersion during childbirth: a qualitative thematic synthesis

Background The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence‑based care aimed at promoting women’s participation in informed decision‑making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women’s autonomy and well‑being during child‑ birth. Currently, water immersion is used as a non‑pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women’s and midwives’ experiences, values, and prefer‑ ences regarding water immersion during childbirth. Methods A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non‑qualita‑ tive studies, mixed‑methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. Results Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. Conclusions The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rig‑ orous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results

Modelling aboveground net primary production (ANPP) of an Atlantic mountain grassland based on time series approach

Because primary productivity is related both with the energy that sustains food webs and with species diversity, it is usually considered a key ecosystem property and a reliable indicator of available forage. In this work the aboveground net primary production (ANPP) of an Atlantic mountain grassland system was modelled in order to attempt producing short-term forecasts. Since grazing influences productivity, two treatment levels (grazing and exclusion) were experimentally applied in each of three field sites. Monthly ANPP data were then collected over three consecutive vegetative periods (2006-2008), thereby obtaining six time series (one per plot). Since no significant differences among sites (within treatments) were found, these six series were later reduced through averaging to only two series (one per treatment level). Two kinds of statistical models were then used to attempt monthly ANPP forecasting: exponential smoothing methods and ARIMA models. Both methodologies turned out to produce inadequate forecasts due to the presence of marked local features (innovative outliers) in our relatively short time-series data. Nonetheless, useful information for a more innovative shepherding management was revealed (e.g. the presence of within-year variation in ANPP, and differences between the grazing and exclusion treatments). Longer data series, which would require a more demanding effort in sampling investment, are likely necessary in order to obtain adequate forecasts using these time series methodologies.Debido a que la producción primaria está relacionada tanto con la energía que sustenta las redes tróficas como con la diversidad de especies, generalmente se considera una propiedad clave del ecosistema y un indicador fiable del forraje disponible. En este trabajo se modeló la producción primaria neta aérea (ANPP) de un sistema de pastizales atlánticos de montaña con el fin de intentar pronosticarla a corto plazo. Como el pastoreo influye en la productividad, se aplicaron experimentalmente dos niveles de tratamiento (pastoreo y exclusión) en cada uno de los tres sitios de estudio. Los datos mensuales de ANPP se recolectaron a lo largo de tres períodos vegetativos consecutivos (2006-2008), obteniendo así seis series temporales (una por parcela). Dado que no se encontraron diferencias significativas entre los sitios (dentro de los tratamientos), estas seis series fueron promediadas y reducidas a dos (una por nivel de tratamiento). Posteriormente, se utilizaron dos tipos de modelos estadísticos para pronosticar la ANPP mensual: métodos de suavizado exponencial y modelos ARIMA. Ambas metodologías arrojaron pronósticos inadecuados debido a la presencia de características locales marcadas (valores atípicos innovadores) en nuestros datos de series temporales relativamente cortas. No obstante, se reveló información útil para un diseño de manejo del pastoreo más adecuado (por ejemplo, la presencia de variación dentro de un año en la ANPP y diferencias entre los tratamientos de pastoreo y exclusión). Es probable que se necesiten series de datos más largas, lo que requeriría un esfuerzo más exigente en la inversión de muestreo, para obtener predicciones adecuadas utilizando estas metodologías de series temporales

Alpha-particle Emission Probabilities in the Decay of 235U

235U decays by alpha particle emission to 23I Th. The decay scheme of this nuclide is very complex, with more than 20 alpha branches. Recommended values for Palpha of this nuclide are based on measurements carried out in 1975. This work presents the results of new measurements made with SI detectors and sources of enriched uranium in the frame of the EUROMET 591 cooperation project. The use of improved measurement techniques and numerical analysis of spectra allowed a new set of P alpha values for 13 lines with improved uncertainties to be obtained.JRC.D.4-Isotope measurement