Study protocol to investigate the effect of a lifestyle intervention on body weight, psychological health status and risk factors associated with disease recurrence in women recovering from breast cancer treatment

Background Breast cancer survivors often encounter physiological and psychological problems related to their diagnosis and treatment that can influence long-term prognosis. The aim of this research is to investigate the effects of a lifestyle intervention on body weight and psychological well-being in women recovering from breast cancer treatment, and to determine the relationship between changes in these variables and biomarkers associated with disease recurrence and survival. Methods/design Following ethical approval, a total of 100 patients will be randomly assigned to a lifestyle intervention (incorporating dietary energy restriction in conjunction with aerobic exercise training) or normal care control group. Patients randomised to the dietary and exercise intervention will be given individualised healthy eating dietary advice and written information and attend moderate intensity aerobic exercise sessions on three to five days per week for a period of 24 weeks. The aim of this strategy is to induce a steady weight loss of up to 0.5 Kg each week. In addition, the overall quality of the diet will be examined with a view to (i) reducing the dietary intake of fat to ~25% of the total calories, (ii) eating at least 5 portions of fruit and vegetables a day, (iii) increasing the intake of fibre and reducing refined carbohydrates, and (iv) taking moderate amounts of alcohol. Outcome measures will include body weight and body composition, psychological health status (stress and depression), cardiorespiratory fitness and quality of life. In addition, biomarkers associated with disease recurrence, including stress hormones, estrogen status, inflammatory markers and indices of innate and adaptive immune function will be monitored. Discussion This research will provide valuable information on the effectiveness of a practical, easily implemented lifestyle intervention for evoking positive effects on body weight and psychological well-being, two important factors that can influence long-term prognosis in breast cancer survivors. However, the added value of the study is that it will also evaluate the effects of the lifestyle intervention on a range of biomarkers associated with disease recurrence and survival. Considered together, the results should improve our understanding of the potential role that lifestyle-modifiable factors could play in saving or prolonging lives

PREMIUM, a benchmark on the quantification of the uncertainty of the physical models in the system thermal-hydraulic codes: methodologies and data review

The objective of the Post-BEMUSE Reflood Model Input Uncertainty Methods (PREMIUM) benchmark is to progress on the issue of the quantification of the uncertainty of the physical models in system thermalhydraulic codes by considering a concrete case: the physical models involved in the prediction of core reflooding. The present document was initially conceived as a final report for the Phase I “Introduction and Methodology Review” of the PREMIUM benchmark. The objective of Phase I is to refine the definition of the benchmark and publish the available methodologies of model input uncertainty quantification relevant to the objectives of the benchmark. In this initial version the document was approved by WGAMA and has shown its usefulness during the subsequent phases of the project. Once Phase IV was completed, and following the suggestion of WGAMA members, the document was updated adding a few new sections, particularly the description of four new methodologies that were developed during this activity. Such developments were performed by some participants while contributing to PREMIUM progress (which is why this report arrives after those of other phases). After this revision the document title was changed to “PREMIUM methodologies and data review”. The introduction includes first a chapter devoted to contextualization of the benchmark in nuclear safety research and licensing, followed by a description of the PREMIUM objectives. Next, a description of the Phases in which the benchmark is divided and its organization is explained. Chapter two consists of a review of the involvement of the different participants, making a brief explanation of the input uncertainty quantification methodologies used in the activity. The document ends with some conclusions on the development of Phase I, some more general remarks and some statements on the benefits of the benchmark, which can be briefly summarized as it follows: - Contribution to development of tools and experience related to uncertainty calculation and promotion of the use of BEPU approaches for licensing and safety assessment purposes; - Contribution to prioritization of improvements to thermal-hydraulic system codes; - Contribution to a fluent and close interaction between the scientific community and regulatory organizations. Appendices include the complete description of the experimental data FEBA/SEFLEX used in the benchmark and the methodologies CIRCÉ and FFTBM and the general requirements and description specification used for Phase I. Due to the revision of the document, four extra appendixes have been added related to the methods developed during the activity, MCDA DIPE, Tractebel IUQ and PSI methods

Concerted Regulation of cGMP and cAMP Phosphodiesterases in Early Cardiac Hypertrophy Induced by Angiotensin II

Left ventricular hypertrophy leads to heart failure and represents a high risk leading to premature death. Cyclic nucleotides (cAMP and cGMP) play a major role in heart contractility and cyclic nucleotide phosphodiesterases (PDEs) are involved in different stages of advanced cardiac diseases. We have investigated their contributions in the very initial stages of left ventricular hypertrophy development. Wistar male rats were treated over two weeks by chronic infusion of angiotensin II using osmotic mini-pumps. Left cardiac ventricles were used as total homogenates for analysis. PDE1 to PDE5 specific activities and protein and mRNA expressions were explored

Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

BACKGROUND: A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. DISCUSSION: Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. SUMMARY: The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.Peer reviewe

Current concept of abdominal sepsis : WSES position paper

Peer reviewe