Prevalence of tumor BRCA1 and BRCA2 dysfunction in unselected patients with ovarian cancer

Objective@#The therapeutic benefits of poly(ADP-ribose) polymerase inhibitors highlight the need to evaluate BRCA1/2 defects in tubal/ovarian cancer (OC). We sought to determine the pattern and disease characteristics associated with tumor BRCA1/2 mutations and BRCA1 methylation in women with OC. @*Methods@#We obtained 111 OC specimens from 2 university hospitals and assessed BRCA1/2 mutations and BRCA1 methylation in tumor DNA. The frequency and pattern of BRCA1/2 defects were examined. Associations between patient/disease characteristics and BRCA1/2 defects were ascertained (Fisher’s exact test). Platinum-free interval (PFI), progression-free survival (PFS), and overall survival (OS) based on the underlying BRCA1/2 defect were determined (Kaplan-Meier analysis [log-rank test]). @*Results@#We observed a BRCA1/2 dysfunction rate of 40% (28/70) in high-grade serous tubal/ovarian cancer (HGSC), including 14.3% BRCA1 methylation (n=10), 7.1% BRCA1 mutation (n=5), and 18.6% BRCA2 mutation (n=13). Defects in BRCA1/2 genes were associated with stage III/IV HGSC (BRCA1 methylation: P=0.005 [stage III/IV] and P=0.004 [HGSC]; BRCA1/2 mutation: P=0.03 [stage III/IV] and P<0.001 [HGSC]). Patients with BRCA1/2-mutated cancers showed improved OS (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43–0.99; P=0.045) and a trend toward improved PFI (HR, 0.48; 95% CI, 0.22–1.06; P=0.07) and PFS (HR, 0.72; 95% CI, 0.51–1.03; P=0.07). No survival differences were observed between BRCA1-methylated and BRCA1/2 wild-type non-BRCA1-methylated cancers. @*Conclusion@#We observed a high tumor BRCA1/2 dysfunction rate in HGSC with a unique predominance of BRCA2 over BRCA1 mutations. While BRCA1/2 mutations conferred survival benefits in OC, no such association was observed with BRCA1 methylation.

Prevalence of tumor BRCA1 and BRCA2 dysfunction in unselected patients with ovarian cancer

Objective@#The therapeutic benefits of poly(ADP-ribose) polymerase inhibitors highlight the need to evaluate BRCA1/2 defects in tubal/ovarian cancer (OC). We sought to determine the pattern and disease characteristics associated with tumor BRCA1/2 mutations and BRCA1 methylation in women with OC. @*Methods@#We obtained 111 OC specimens from 2 university hospitals and assessed BRCA1/2 mutations and BRCA1 methylation in tumor DNA. The frequency and pattern of BRCA1/2 defects were examined. Associations between patient/disease characteristics and BRCA1/2 defects were ascertained (Fisher’s exact test). Platinum-free interval (PFI), progression-free survival (PFS), and overall survival (OS) based on the underlying BRCA1/2 defect were determined (Kaplan-Meier analysis [log-rank test]). @*Results@#We observed a BRCA1/2 dysfunction rate of 40% (28/70) in high-grade serous tubal/ovarian cancer (HGSC), including 14.3% BRCA1 methylation (n=10), 7.1% BRCA1 mutation (n=5), and 18.6% BRCA2 mutation (n=13). Defects in BRCA1/2 genes were associated with stage III/IV HGSC (BRCA1 methylation: P=0.005 [stage III/IV] and P=0.004 [HGSC]; BRCA1/2 mutation: P=0.03 [stage III/IV] and P<0.001 [HGSC]). Patients with BRCA1/2-mutated cancers showed improved OS (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43–0.99; P=0.045) and a trend toward improved PFI (HR, 0.48; 95% CI, 0.22–1.06; P=0.07) and PFS (HR, 0.72; 95% CI, 0.51–1.03; P=0.07). No survival differences were observed between BRCA1-methylated and BRCA1/2 wild-type non-BRCA1-methylated cancers. @*Conclusion@#We observed a high tumor BRCA1/2 dysfunction rate in HGSC with a unique predominance of BRCA2 over BRCA1 mutations. While BRCA1/2 mutations conferred survival benefits in OC, no such association was observed with BRCA1 methylation.

Burnout in the emergency department: Randomized controlled trial of an attention-based training program / 中西医结合学报

BACKGROUND@#Burnout (encompassing emotional exhaustion, depersonalization and personal accomplishment) in healthcare professionals is a major issue worldwide. Emergency medicine physicians are particularly affected, potentially impacting on quality of care and attrition from the specialty.@*OBJECTIVE@#The aim of this study was to apply an attention-based training (ABT) program to reduce burnout among emergency multidisciplinary team (MDT) members from a large urban hospital.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#Emergency MDT members were randomized to either a no-treatment control or an intervention group. Intervention group participants engaged in a four session (4 h/session) ABT program over 7 weeks with a practice target of 20 min twice-daily. Practice adherence was measured using a smart phone application together with a wearable Charge 2 device.@*MAIN OUTCOME MEASURES@#The primary outcome was a change in burnout, comprising emotional exhaustion, depersonalization and personal achievement. The secondary outcomes were changes in other psychological and biometric parameters.@*RESULTS@#The ABT program resulted in a significant reduction (P < 0.05; T1 [one week before intervention] vs T3 [follow-up at two months after intervention]) in burnout, specifically, emotional exhaustion, with an effect size (probability of superiority) of 59%. Similar reductions were observed for stress (P < 0.05) and anxiety (P < 0.05). Furthermore, ABT group participants demonstrated significant improvements in heart rate variability, resting heart rate, sleep as well as an increase in pro-inflammatory cytokine expression.@*CONCLUSION@#This study describes a positive impact of ABT on emergency department staff burnout compared to a no-treatment control group.@*TRIAL REGISTRATION@#ClinicalTrials.gov identifier NCT02887300.

Asociación de tumorlet pulmonar con segundas neoplasias / Pulmonary tumorlet associated with second neoplasia

Los tumorlets son tumores neuroendocrinos pulmonares menores a 0.5 cm, de evolución benigna y habitualmente asintomáticos. Su diagnóstico es importante para realizar la diferenciación con otras afecciones neuroendocrinas y enfermedad metastásica de otro origen, que requerirán una intervención terapéutica. Se presenta un caso de dicha entidad asociada a otros tumores.

Tumorlets are pulmonary neuroendocrine tumors smaller than 0.5 cm. They are benign and usually asymptomatic. Their diagnosis is important so as to differentiate them from other neuroendocrine pathologies that require therapeutic intervention. We report a case of such entity and a discussion on the subject that can contribute to highlight the importance of diagnosing this entity.

Combined Type II Odontoid Fracture with Jefferson's Fracture Treated with Temporary Internal Fixation

An 18-year-old male presented after a motor vehicle rollover accident. Computed tomography (CT) scan confirmed the diagnosis of Type II odontoid fracture. Considering the patient's young age and the limitations of C1-C2 fusion including significant loss of cervical rotation, temporary internal fixation with a lateral mass fixation of C1 and pedicle fixation of C2 without fusion was done. CT scan done at 6-month follow-up visit showed healed odontoid fracture and excellent C1-C2 alignment. At ninth postoperative month, internal fixation was removed. Patient had normal movements of cervical spine at 1-year follow-up. Temporary internal fixation can be an important tool in the armamentarium of the surgeon in treating type II odontoid fractures in young adults and children. This strategy avoids the complications halo fixation and immobilizes the unstable C1-C2 segment without fusion. Removal of the internal fixation after healing allows restoration of the rotational motion.

Community Level Fortification: Lessons from Projects in Malawi, Senegal and Tanzania.

Objectives: Rural smallholder farming communities are inadequately reached by national food fortification initiatives. World Vision projects in Malawi, Senegal and Tanzania explored the implementation and sustainability potential for community level fortification to increase households' access to micronutrients. Methods: Fortification projects were initiated within an integrated nutrition and health program. Micronutrient premix was added to staple grains during milling at medium scale mills (Malawi), village hammermills (Malawi, Tanzania) or at home after milling (Senegal, Tanzania). In Senegal two community bakeries for fortified bread were established. Partial cost-recovery systems were implemented in all projects but sustainability plans in Malawi and Senegal relied on a transition to independent business models to fund ongoing premix and quality control costs, with community oversight. Results: The projects introduced a novel method of increasing micronutrient intake which was widely accepted by local communities. More than 20,000 households accessed fortified grains. Common challenges included accessibility of premix supply and quality control services, and costrecovery. Operating in rural areas increased premix supply costs and limited quality control monitoring by national standards agencies. Sustainability of activities without external funding was limited. Transition to cost-recovery was overcome in Malawi through extensive community sensitization but resulted in a shift to food-to-food fortification in Tanzania. In Senegal, community committees sustained premix procurement through fortified bread sales. Conclusions: Community level fortification was well accepted and has potential to improve micronutrient intake of rural households unreached by commercially fortified products. Further formative work is needed to identify contextually feasible systems for premix supply, quality control and cost recovery.

Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography.

Left ventricular assist devices (LVAD) are increasingly used for mechanical circulatory support of patients with severe heart failure, primarily as a bridge to heart transplantation. Transesophageal echocardiography (TEE) plays a major role in the clinical decision making during insertion of the devices and in the post‑operative management of these patients. The detection of structural and device‑related mechanical abnormalities is critical for optimal functioning of assist device. In this review article, we describe the usefulness of TEE for optimal perioperative management of patients presenting for HeartWare LVAD insertion.

Cáncer de pulmón de células no pequeñas: La biología molecular del tumor sugiere decisiones terapéuticas / Non-small lung cáncer. The tumor molecular biology suggests therapeutics decissions

El cáncer de pulmón de células no pequeñas (non-small cells lung cancer, NSCLC) es una patología etiológicamente heterogénea, donde factores genéticos y ambientales interaccionan contribuyendo a su desarrollo. Los descubrimientos recientes en genómica y proteómica, y los estudios de expresión de genes en cáncer han permitido clarificar los eventos moleculares que generan el desarrollo y la progresión de esta patología.

The relationship between overactive bladder and sexual activity in women

PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by ³ 60 percent of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25 percent of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.

Parotid lymphomas - clinical and computed tomographic imaging features : otolaryngology

Objective. To review the clinical presentation and computed tomography (CT) imaging characteristics of all parotid lymphomas diagnosed at the study institution over a 7-year period. Design. Retrospective chart review of parotid lymphomas diagnosed between 1997 and 2004. Subjects. A total of 121 patients with parotid lesions were identified. After retrospective chart review; a total of 10 patients with histologically proven parotid lymphoma were included in the study; 8 of whom had CT scans available for assessment. Results. Ten patients with histologically proven lymphoma of the parotid gland were identified from among 121 patients with parotid neoplasms; an incidence in this series of 8.3. All lymphomas were of nonhodgkin's type. All patients presented with a painless unilateral parotid swelling. Most patients had a short history of less than 4 months' duration; of whom 3 presented with a rapidly evolving swelling of less then 1 month's duration. No patient had a background of SjA gren's disease or any other autoimmune disorders. The commonest finding noted on CT was of a unilateral; single mass of relative soft-tissue homogeneity with poorly defined; indistinct tumour margins. Associated loco-regional lymphadenopathy was identified in 2 cases; 1 clinically and another radiologically; multiple ipsilateral lesions were noted in 2 cases. No cases of contralateral disease were observed. Conclusion. Lymphoma has a clinical presentation similar to other neoplasms arising within the parotid gland. A unilateral; non-tender swelling was a universal finding. A history of less than 4 months may suggest the possibility of lymphoma. CT scanning is a useful adjunctive investigation to determine the site and extent of the disease; loco-regional nodal status and contralateral gland and neck status. Multifocality and associated adenopathy are associated with; but not exclusive to; parotid lymphoma. Although poor tumour boundary definition on CT imaging is a strong predictor of malignancy; no pathognomonic finding specific for lymphoma has been identified. The potential diagnosis of parotid lymphoma should be considered in all patients who present with a parotid mass

New Antiviral Therapies for Hepatitis C / 대한간학회지

No abstract available.

Effect of Aubergiene (Solanum melongena) on Serum and Hepatic Cholesterol and Triglycerides in rats

A beringela (Solanum melongena) tem sido apontada como possuidora da capacidade de reduzir o colesterol sérico. O chá do vegetal vem senso utilizado com este propósito, devido ao interesse na descoberta de formas alternativas para o controle da hipercolesterolemia. No presente trabalho testou-se o efeito do chá de beringela no níveis séricos e hepáticos de colesterol e triglicerídeos em ratos adultos. Ratos Fisher foram divididos em tres grupos: o primeiro recebeu dieta normolipídica ad libitum e água para beber, funcionando como controle; os outros dois receberam dieta hipercolesterolêmica com 30 por cento de óleo vegetal e 1 por cento de colesterol, sendo dada a um destes grupos água para beber, enquanto que o outro recebeu apenas chá de beringela. Após 28 dias os animais foram sacrificados e dosaram-se os níveis de colesterol e triglicerídeos séricos e hepáticos. Os resultados obtidos indicam que, nas condiçöes experimentais utilizadas, o chá de beringela eleva o colesterol sérico, reduz o hepático e tem pouco ou nenhum efeito sobre os triglicerídeos, tanto séricos quanto hepáticos

Sindrome nefrotico agudo asociado a sifilis secundaria / Acute nephrotic syndrome associated with secondary syphilis

Se presenta a una paciente de 38 años con síndrome nefrótico y rash cutáneo, sin antecedentes patológicos. Al ingreso presentaba lesiones máculo papulares no pruriginosas en tronco y extremidades de veinte días de evolución, edema bipalpebral bilateral y de miembros inferiores desde la semana previa. El laboratorio informó función renal normal com proteinuria de 10g/día, proteínas séricas de 4.20 g/dl., albúmina 1.78 g/dl., colesterol 334 mg/l, VDRL(+) 1/32 dils, FTA abs.(+), HIV no reactivo, colagenograma normal. Se interpretó el cuadro como síndrome nefrótico asociado a sífilis secundaria y se trató con penicilina, reposo, restricción de sal, observándose buena evolución aún antes de completado el tratamiento y resolución completa después de la tercera semana. La incidencia de compromiso renal asociado a estadios precoces de la sífilis es menor de 0.3 por ciento. Creemos de interés llamar la atención de esta asociación que por ser rara puede pasar inadvertida.

A tripla ameaça: mulheres e AIDS. Dossiê Panos / The triple treat: women and AIDS. Dossier Panos

Discute os três níveis de ameaça que representa a AIDS para as mulheres: a contaminaçäo que compromete suas vidas, a contaminaçäo de suas crianças e os efeitos da epidemia, que a atingiräo na medida em que iräo cuidar, em casa, de familiares doentes de AIDS. Analisa os riscos de contaminaçäo por via sexual, a escolha do comportamento sexual, a AIDS e a reproduçäo, doenças por HIV nas crianças, os custos da assistência à AIDS e finalmente a prevençäo da doença (AMSB)