A prospective, single-centre, single-arm, open label study of the long term use of a gonadotropin releasing hormone agonist (Triptorelin SR, 11.25 mg) in combination with Tibolone add-back therapy in the management of chronic cyclical pelvic pain.

BACKGROUND: Chronic cyclic pelvic pain (CCPP) affects women's quality of life and pituitary downregulation is often used for symptomatic relief. However, prolonged suppression of ovarian function is associated with menopausal side effects and can lead to osteoporosis. Currently, the use of gonadotropin releasing hormone agonists (GnRHa) for treatment of CCPP is usually restricted to 6-9 months, limiting their efficacy. There is limited information regarding safety and efficacy with longer-term use. The aim of this study is to examine the safety and efficacy of long-term (24 months) pituitary down-regulation with the GnRHa (Triptorelin SR) with add-back therapy (ABT) using Tibolone for symptom relief in women with CCPP. METHODS: A single-arm, prospective clinical trial at a Tertiary University Teaching Hospital of 27 patients receiving Triptorelin SR (11.25 mg) and Tibolone (2.5 mg). Outcomes measures were the safety of treatment assessed by clinical examination, haematological markers, liver and renal function tests and bone mineral density (BMD) at 12, 18 and 24 months as well as at 6 months post-treatment. Pain and health-related quality of life (HR-QoL) assessed using the endometriosis health profile (EHP-30) and chronic pain grade (CPG) questionnaires. RESULTS: There was no evidence for any significant harmful effects on any of the measured haematological, renal or liver function tests. Although results regarding the effect on BMD are not conclusive there is an increased risk of development of osteopaenia after 12 months of treatment. Pain and HRQoL assessments showed significant improvement during medication, but with deterioration after treatment cessation. CONCLUSION: Long- term Triptorelin plus Tibolone add-back therapy in women suffering from CCPP does not appear to be associated with significant serious adverse events apart from the possibility of deterioration in the BMD that needs to be monitored. This mode of therapy appears to be effective in pain relief and in improving quality of life over a 24-month period. TRIAL REGISTRATION: Clinical trials database NCT00735852

Tuning structural relaxations, mechanical properties, and degradation timescale of PLLA during hydrolytic degradation by blending with PLCL-PEG

Poly-L-lactide (PLLA) is a popular choice for medical devices due to its bioresorbability and superior mechanical properties compared with other polymers. However, although PLLA has been investigated for use in bioresorbable cardiovascular stents, it presents application-specific limitations which hamper device therapies. These include low toughness and strength compared with metals used for this purpose, and slow degradation. Blending PLLA with novel polyethylene glycol functionalised poly(L-lactide-co-$\varepsilon$-caprolactone) (PLCL-PEG) materials has been investigated here to tailor the mechanical properties and degradation behaviour of PLLA. This exciting approach provides a foundation for a next generation of bioresorbable materials whose properties can be rapidly tuned. The degradation of PLLA was significantly accelerated by addition of PLCL-PEG. After 30 days of degradation, several structural changes were observed in the polymer blends, which were dependent on the level of PLCL-PEG addition. Blends with low PLCL-PEG content displayed enthalpy relaxation, resulting in embrittlement, while blends with high PLCL-PEG content displayed crystallisation, due to enhanced chain mobility brought on by chain scission, also causing embrittlement. Moderate PLCL-PEG additions (10% PLCL(70:30)-PEG and 20 - 30% PLCL(80:20)-PEG) stabilised the structure, reducing the extent of enthalpy relaxation and crystallisation and thus retaining ductility. Compositional optimisation identified a sweet spot for this blend strategy, whereby the ductility was enhanced while maintaining strength. Our results indicate that blending PLLA with PLCL-PEG provides an effective method of tuning the degradation timescale and mechanical properties of PLLA, and provides important new insight into the mechanisms of structural relaxations that occur during degradation, and strategies for regulating these.Lucideon Lt

Asymptotic and numerical analysis of a simple model for blade coating

Motivated by the industrial process of blade coating, the two-dimensional flow of a thin film of Newtonian fluid on a horizontal substrate moving parallel to itself with constant speed under a fixed blade of finite length in which the flows upstream and downstream of the blade are coupled via the flow under the blade is analysed. A combination of asymptotic and numerical methods is used to investigate the number and nature of the steady solutions that exist. Specially, it is found that in the presence of gravity there is always at least one, and (depending on the parameter values) possibly as many as three, steady solutions, and that when multiple solutions occur they are identical under and downstream of the blade, but differ upstream of it. The stability of these solutions is investigated, and their asymptotic behaviour in the limits of large and small flux and weak and strong gravity effects, respectively, determined

Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study

Introduction: Low uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. / Methods: This is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55–77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study—a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs’ associations with uptake (telephoning for an appointment) and sociodemographic characteristics. / Results: Higher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. / Conclusions: Interventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high

Electronic transitions of iron in almandine-composition glass to 91 GPa

Valence and spin states of Fe were investigated in a glass of almandine (Fe$_3$Al$_2$Si$_3$O$_{12}$) composition to 91 GPa by X-ray emission spectroscopy and energy- and time-domain synchrotron Mössbauer spectroscopy in the diamond-anvil cell. Changes in optical properties, total spin moment and Mössbauer parameters all occur predominantly between 1 bar and ~30 GPa. Over this pressure range, the glass changes from translucent brown to opaque and black. The total spin moment of the glass derived from X-ray emission spectroscopy decreases by ~20%. The complementary Mössbauer spectroscopy approaches reveal consistent changes in sites corresponding to 80–90% Fe$^{2+}$ and 10–20% Fe$^{3+}$. The high-spin Fe$^{2+}$ doublet exhibits a continuous decrease in isomer shift and increase in line width and asymmetry. A high-spin Fe$^{3+}$ doublet with quadrupole splitting of ~1.2 mm/s is replaced by a doublet with quadrupole splitting of ~1.9 mm/s, a value higher than all previous measurements of high-spin Fe$^{3+}$ and consistent with low-spin Fe$^{3+}$. These observations suggest that Fe$^{3+}$ in the glass undergoes a continual transition from a high-spin to a low-spin state between 1 bar and ~30 GPa. Almandine glass is not expected to undergo any abrupt transitions in electronic state at deep mantle pressures.National Science FoundationThis is the author accepted manuscript. The final version is available from the Mineralogical Society of America via http://dx.doi.org/10.2138/am-2016-560

Imaging the paediatric lung: what does nanotechnology have to offer?

This review will provide an overview of current research into lung imaging with nanoparticles, with a focus on the use of nanoparticles as molecular imaging agents to observe pathological processes and to monitor the effectiveness of nanoparticulate drug delivery systems. Various imaging modalities together with their advantages and limitations for lung imaging will be discussed. We will also explore the range of nanoparticles used, as well as active or passive targeting of nanoparticles

Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials

Rationale: Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity. Objectives: To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening. Methods: In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: 1) aged 60 to 75 years, 2) recorded as a current smoker within the last 7 years, and 3) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group’s leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport’s annual vehicle test (“M.O.T. For Your Lungs”). Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82–1.16) or adjusted (OR, 0.98; 95% CI, 0.82–1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56–0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (P < 0.01). Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real-world studies, particularly given that the samples were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard. Clinical trial registered with www.clinicaltrials.gov (NCT02558101) and registered prospectively with the International Standard Registered Clinical/Social Study (N21774741)