16 research outputs found

    Organisational risks matter and should be discussed during consent: survey of 980 neurosurgery patients from the UK

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    Introduction During consent, surgeons discuss surgical and anaesthetic risks with patients. We investigated whether patients also wish to be informed about hospital organisational risks. Methods We used a cross-sectional survey. A questionnaire with three real-life scenarios of hospital organisational problems likely to increase the risk of surgery was given to 1,003 patients in neurosurgical departments of three United Kingdom (UK) teaching hospitals. The scenarios were: (1) computer failure in the operating room; (2) lack of surgical equipment; and (3) bed shortage or lack of operating capacity causing postponement of surgery. We quantified how strongly participants wish to be informed about organisational risks, whether this information alters a patient’s decision to have surgery, and the desire of patients to discuss these risks further. Results In total, 980 of 1,003 (97.7%) questionnaires were returned and 84.3%–88.5% of patients wished to be informed about hospital organisational risks – more women than men (odds ratio [OR] 1.6–1.8, p < 0.05). Knowledge of the hospital organisational risks would influence 69.2%–70.4% of participants’ decisions to have surgery; 74.9%–78.3% of participants wished to discuss the organisational risks with surgeons and 50.0%–60.8% with hospital managers before surgery. Some 69.4% of patients were concerned about organisational risks vs 77.1% who were concerned about surgical risks. Conclusions Most neurosurgery patients consider hospital organisational risks to be material. To comply with the Montgomery ruling in UK medicolegal case law, neurosurgeons and hospital managers should discuss with patients the organisational risks in addition to the surgical and anaesthetic risks during consent

    Abstract 3571: The Thioredoxin Reductase Inhibitor Chaetocin has Potent Antineoplastic Effects in Solid Tumors

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    Abstract Background: We had previously reported that the natural product chaetocin has potent and selective in vitro, ex vivo and in vivo anti-myeloma activity attributable to the imposition of cellular oxidative stress (ROS) in part mediated via competitive inhibition of the redox enzyme thioredoxin reductase. Having also observed chaetocin-induced cytotoxicity in solid tumor cell lines, we now extend prior work to characterize the effects of chaetocin in solid tumor cell lines and in human umbilical vein endothelial cells (HUVECs). Methods: The effects of chaetocin in solid tumor cell lines were assessed using colony forming assays, trypan blue exclusion assays, apoptosis and autophagy assays, electron microscopy, transcriptional profiling, and the National Cancer Institute 60 cell line screen. Results: Chaetocin demonstrated potent anti-cancer activity in all assessed solid tumor cell lines with IC50 values between 2-10 nM (24 h exposures, colony forming assays). While apoptosis was induced in a cell line-dependant fashion, it was not required for chaetocin-induced cytotoxicity, as ZVAD-fmk prevented apoptosis but not cell death. Markers of autophagy were not altered by chaetocin treatment. Interestingly, results form the NCI 60 cell line screen showed that hematological cell lines were generally more resistant to chaetocin than solid tumor lines despite our prior report indicating the activity of chaetocin in myeloma. Transcriptional profiling results were consistent with those anticipated from an agent producing cell death via imposition of cellular ROS, with heme oxidase-1 prominently induced along with other transcripts in pathways related to inflammatory response and cell death. Results from OxyBlot protein oxidation kit analyses (Millipore, Billerica, MA) confirmed a generalized increase in the carbonyl modification of proteins, a hallmark of cellular oxidative damage, in response to chaetocin treatment. Experiments using Rho0 mitochondrial inactive cells indicated that cellular ROS is induced by chaetocin independent of respiratory functional mitochondria. Chaetocin was also shown to block the interleukin-, fibroblast growth factor- or EGM2 media-induced proliferation of HUVEC cells at low-nanomolar concentrations. Conclusions: Chaetocin has wide-ranging antineoplastic activity across not only hematological, but also solid tumor, cell lines and displays evidence of antiangiogentic activity in HUVEC proliferation assays. Overall, chaetocin appears to be an attractive agent for further development as a candidate anti-cancer therapeutic in a variety of neoplasms. Supported in part by CA125750. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3571.</jats:p

    Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome: A Systematic Review and Meta-analysis

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    Importance: Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The best management options for patients with SIH are still uncertain. Objective: To provide an objective summary of the available evidence on the clinical presentation, investigations findings, and treatment outcomes for SIH. Data Sources: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline-compliant systematic review and meta-analysis of the literature on SIH. Three databases were searched from inception to April 30, 2020: PubMed/MEDLINE, Embase, and Cochrane. The following search terms were used in each database: spontaneous intracranial hypotension, low CSF syndrome, low CSF pressure syndrome, low CSF volume syndrome, intracranial hypotension, low CSF pressure, low CSF volume, CSF hypovolemia, CSF hypovolaemia, spontaneous spinal CSF leak, spinal CSF leak, and CSF leak syndrome. Study Selection: Original studies in English language reporting 10 or more patients with SIH were selected by consensus. Data Extraction and Synthesis: Data on clinical presentation, investigations findings, and treatment outcomes were collected and summarized by multiple observers. Random-effect meta-analyses were used to calculate pooled estimates of means and proportions. Main Outcomes and Measures: The predetermined main outcomes were the pooled estimate proportions of symptoms of SIH, imaging findings (brain and spinal imaging), and treatment outcomes (conservative, epidural blood patches, and surgical). Results: Of 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffness (43% [95% CI, 32%-53%]). Brain magnetic resonance imaging was the most sensitive investigation, with diffuse pachymeningeal enhancement identified in 73% (95% CI, 67%-80%) of patients. Brain magnetic resonance imaging findings were normal in 19% (95% CI, 13%-24%) of patients. Spinal neuroimaging identified extradural cerebrospinal fluid in 48% to 76% of patients. Digital subtraction myelography and magnetic resonance myelography with intrathecal gadolinium had high sensitivity in identifying the exact leak site. Lumbar puncture opening pressures were low, normal (60-200 mm H2O), and high in 67% (95% CI, 54%-80%), 32% (95% CI, 20%-44%), and 3% (95% CI, 1%-6%), respectively. Conservative treatment was effective in 28% (95% CI, 18%-37%) of patients and a single epidural blood patch was successful in 64% (95% CI, 56%-72%). Large epidural blood patches (>20 mL) had better success rates than small epidural blood patches (77% [95% CI, 63%-91%] and 66% [95% CI, 55%-77%], respectively). Conclusions and Relevance: Spontaneous intracranial hypotension should not be excluded on the basis of a nonorthostatic headache, normal neuroimaging findings, or normal lumbar puncture opening pressure. Despite the heterogeneous nature of the studies available in the literature and the lack of controlled interventional studies, this systematic review offers a comprehensive and objective summary of the evidence on SIH that could be useful in guiding clinical practice and future research

    Factores relacionados en las estrategias de afrontamiento que utilizan las mujeres gestantes con diagnóstico de cáncer de mama de Latinoamérica y España

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    El presente estudio, realizado a partir de una revisión sistemática de la literatura tiene como objetivo identificar los factores relacionados a las estrategias de afrontamiento que surgen a partir de un diagnóstico de cáncer de mama al momento de estar en gestación. Con los resultados obtenidos se revelo cómo se genera la génesis social del afrontamiento y su estrecha relación a las estrategias a nivel individual y familiar en Latinoamérica y España. Además, se destaca en los hallazgos la relación positiva del afrontamiento con la salud, la funcionalidad del sistema familiar y la importancia del papel de la psicooncologíaThe present study, carried out from a systematic review of the literature, aims to identify the factors related to coping strategies that arise from a diagnosis of breast cancer at the time of pregnancy. With the results obtained, it was revealed how the social genesis of coping is generated and its close relationship to strategies at the individual and family level in Latin America and Spain. Likewise, the positive relationship between coping with health and the functionality of the family system and the importance of the role of psycho-oncology are highlighted in the [email protected]@campusucc.edu.c

    Arts-based methods for facilitating meta-level learning in management education: Making and expressing refined perceptual distinctions

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    Arts-based methods are increasingly used to facilitate meta-level learning in management education. Such increased use suggests that these methods are relevant and offer a unique contribution meeting a need in today’s management education. Yet, the literature is not clear on what this unique contribution may be even though it abounds with suggestions of varying quality. To explore this matter, I conduct a systematic literature review focused on arts-based methods, management education, and meta-level learning. I find that the unique contribution of arts-based methods is to foreground the process of making and expressing more refined perceptual distinctions, not to get accurate data, but as integral to our thinking/learning. This finding is important, because it imply that certain (commonly applied) ways of using arts-based methods may limit their potential. Finally, I suggest that future research regarding arts-based methods should focus on exploring the impact the process of learning to make and express more refined perceptual distinctions may have on managerial practice to further understand the relevance of these methods to managers

    Pazopanib versus Sunitinib in metastatic renal-cell carcinoma

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    BACKGROUND: Pazopanib and sunitinib provided a progression-free survival benefit, as compared with placebo or interferon, in previous phase 3 studies involving patients with metastatic renal-cell carcinoma. This phase 3, randomized trial compared the efficacy and safety of pazopanib and sunitinib as first-line therapy. METHODS: We randomly assigned 1110 patients with clear-cell, metastatic renal-cell carcinoma, in a 1:1 ratio, to receive a continuous dose of pazopanib (800 mg once daily; 557 patients) or sunitinib in 6-week cycles (50 mg once daily for 4 weeks, followed by 2 weeks without treatment; 553 patients). The primary end point was progression-free survival as assessed by independent review, and the study was powered to show the noninferiority of pazopanib versus sunitinib. Secondary end points included overall survival, safety, and quality of life. RESULTS: Pazopanib was noninferior to sunitinib with respect to progression-free survival (hazard ratio for progression of disease or death from any cause, 1.05; 95% confidence interval [CI], 0.90 to 1.22), meeting the predefined noninferiority margin (upper bound of the 95% confidence interval, &lt;1.25). Overall survival was similar (hazard ratio for death with pazopanib, 0.91; 95% CI, 0.76 to 1.08). Patients treated with sunitinib, as compared with those treated with pazopanib, had a higher incidence of fatigue (63% vs. 55%), the hand–foot syndrome (50% vs. 29%), and thrombocytopenia (78% vs. 41%); patients treated with pazopanib had a higher incidence of increased levels of alanine aminotransferase (60%, vs. 43% with sunitinib). The mean change from baseline in 11 of 14 health-related quality-of-life domains, particularly those related to fatigue or soreness in the mouth, throat, hands, or feet, during the first 6 months of treatment favored pazopanib (P&lt;0.05 for all 11 comparisons

    Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

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    Abstract\ud \ud \ud \ud Background\ud \ud Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.\ud \ud \ud \ud Methods\ud \ud The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach.\ud \ud \ud \ud Results\ud \ud The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.\ud \ud \ud \ud Conclusions\ud \ud The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.We thank to National Hepatitis Study Group whose names are listed below, by their collaboration and support in the organization and development of the study at local level: Zulma Medeiros (Centro de Pesquisas Aggeu Magalhães-FIOCRUZ), Demócrito Miranda Filho (Universidade de Pernambuco), Maria Mabel Melo (LACEN-PE), Conceiçao Sá (Hemocentro—HEMOPI-PI), Carlos Henrique Nery Costa (Universidade Federal do Piaui), Arnaldo de Jesus Dominici (Universidade Federal do Maranhao), Maria das Graças Aragão (Universidade Federal do Maranhao), Elizabeth de Souza Lima (LACEN-MA), Jose Milton de Castro Lima (Universidade Federal do Ceara), Jose Wellington Oliveira Lima (FUNASA-CE), Maria do Carmo Vidal Gadelha Lima (LACEN-CE), Gilmar Amorim de Sousa (Universidade Federal do Rio Grande do Norte), Marcia Araujo Barreto (Universidade Federal do Rio Grande do Norte), Manoel Jaime Xavier Filho (Universidade Federal da Paraiba), Joria Viana Guerreiro (Universidade Federal da Paraiba), Dayse Mercia Cavalcanti de Oliveira (FUNASA-AL), Maria Rosileide Bezerra Alves (Secretaria Estadual de Saude de Alagoas), Ivoneide Moreira de Oliveira Barros (LACEN-PB), Tereza Virginia Silva B.Nascimento (Universidade Federal de Sergipe), Lucia Maria Sayde de Azevedo Tavares (FUNASA-SE), Raymundo Parana Ferreira Filho (Universidade Federal da Bahia), Jose Tavares-Neto (Universidade Federal da Bahia), Maria Alice Sant’Anna Zarife (LACEN-BA), Rodrigo Sebba Aires (Secretaria Estadual de Saúde de Goias), Fluvia Pereira A. da Silva (Secretaria Municipal de Saúde de Goiania), Beatriz Maranhao Bariani (LACEN-GO), Jose Ivan Aguiar (Universidade Federal do Mato Grosso do Sul), Eugenio Barros (Secretaria Municipal de Saúde-Campo Grande), Gilza Bastos dos Santos (LACEN-MS), Francisco Souto (Universidade Federal do Mato Grosso), Cor Jesus Fernando Fontes (Universidade Federal do Mato Grosso), Virg?nia Correia de Azevedo (LACEN-MT), Roberto de Melo Dusi (Secretaria Estadual de Saude - DF), L?dia Maria Pinto Luna (LACEN-DF), Jose Carlos da Fonseca (Universidade Federal do Amazonas), Leila Melo Brasil (Fundacao Medicina Tropical do Amazonas), Katia Biscuola de Campos (Programa Nacional de Prevencao e Controle das Hepatites Virais/SVS/ Ministerio da Saude), Cirley Maria de Oliveira Lobato (Serviço de Assistência Especializada - Secretaria Estadual de Saúde- AC), Mônica de Breu Moraes (Secretaria Estadual de Saúde-Acre, Programa Estadual de Hepatites), Janaina Mazaro (LACEN, Rio Branco, Acre), Maria de Nazaré Miranda de Cavalcante (Secretaria de Estado da Saúde de Amapá); Clóvis Omar Sá Miranda (Secretaria de Saúde do Estado do Amapá, Macapá, Amapa, Brazil), Márcia Socorro Cavalcante Porcy (LACEN-Amapa, Brazil), Ana Ruth Silva de Araújo (Universidade Federal do Amazonas), Marlúcia da Silva Garrido (Fundação de Vigilância em Saúde do Amazonas-Departamento de Vigilância Epidemiológica), Márcia Noronha Barbosa (Fundação de Vigilância em Saúde-AM), Raimundo Aldo Tavares (Secretaria Estadual de Saúde Pública - PA), Maria de Fátima Chaves Oliveira (Secretaria Estadual de Saúde-PA), José Américo Lozich de Aquino (LACEN-PA), Juan Miguel Villalobos-Salcedo (Universidade Federal de Rondônia), Fábio Luiz Storer (Faculdade São Lucas, Porto Velho- RO), Luiz Renerys de Lima Pinheiro (Secretaria de Saúde de Estado da Saúde de Roraima), Jacqueline de Aguiar Barros (Secretaria de Estado da Saúde de Roraima), Juliana Cristina Ferreira Lima (LACEN-RR), Nádja Duarte Oliveira Souza (Universidade Federal do Tocantins), Arlete Lopes da Cunha Otoni (Secretaria de Estado da Saúde do Tocantins); Gisele Christina O. Silva (LACEN-TO), Paraná Dominique Muzillo (Universidade Federal do Paraná), Lucimar Bozza (Secretaria Municipal de Saúde de Curitiba); Yatiyo Matsui Moriya (LACEN-Paraná), Esther Buzaglo Dantas-Correa (Universidade Federal de Santa Catarina), Ana Cristina Vidor (Prefeitura Municipal de Florianópolis), Ana Duarte Cardoso (LACEN-SC), Alexandro Alves (Universidade Federal de Ciências da Saúde de Porto Alegre), Maria Eugênia Pinto (Universidade Federal de Ciências da Saúde de Porto Alegre), Zenaida Marion Alves Nunes Lyra Vidal (Instituto de Pesquisa Biologica IPB Lacen RS), Angelica Espinosa Barbosa Miranda (Universidade Federal do Espírito Santo), Moacir Soprani (Secretaria Estadual de Saúde do Espírito Santo), Patrícia Rolim Prates (LACEN-ES), Cristiane Alves Villela-Nogueira (Universidade Federal do Rio de Janeiro), Mariza Miranda Theme-Filha (ENSP-FIOCRUZ), Carlos Augusto da Silva Fernandes (LACEN – RJ), Angela Maria Miranda Spina (Instituto Adolfo Lutz), Flair José Carrilho (Universidade de São Paulo), Antônio Alci Barone (Universidade de São Paulo), Rosângela Teixeira (Universidade Federal de Minas Gerais–UFMG); Keli Bahia Felicíssimo Zocratto (Centro Universitário Newton Paiva), Sônia Conceição Diniz (Secretaria de Estado da Saúde de Minas Gerais).We also thank to the Brazilian Ministry for Health and Pan American Health Organization by the financial support, to the University of Pernambuco Foundation by the administrative support and to the National Institute of Science and Technology for Health Technology Assessment (CNPq) by providing scholarships to R.A.A.X.(n. 308311/2009-4), C.M.T.M. (n. 306489/2010-4) and M.D.T.(n. 306928/2010-8)

    Isospin dependence of electromagnetic transition strengths among an isobaric triplet

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    © 2019 The Author(s) Electric quadrupole matrix elements, Mp, for the Jπ=2+→0+, ΔT=0, T=1 transitions across the A=46 isobaric multiplet 46Cr-46V-46Ti have been measured at GSI with the FRS-LYCCA-AGATA setup. This allows direct insight into the isospin purity of the states of interest by testing the linearity of Mp with respect to Tz. Pairs of nuclei in the T=1 triplet were studied using identical reaction mechanisms in order to control systematic errors. The Mp values were obtained with two different methodologies: (i) a relativistic Coulomb excitation experiment was performed for 46Cr and 46Ti; (ii) a “stretched target” technique was adopted here, for the first time, for lifetime measurements in 46V and 46Ti. A constant value of Mp across the triplet has been observed. Shell-model calculations performed within the fp shell fail to reproduce this unexpected trend, pointing towards the need of a wider valence space. This result is confirmed by the good agreement with experimental data achieved with an interaction which allows excitations from the underlying sd shell. A test of the linearity rule for all published data on complete T=1 isospin triplets is presented
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