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BACKGROUND AND PURPOSE: Partial breast irradiation (PBI)has beenthe Danish Breast Cancer Group(DBCG) standard for selected breast cancer patients since 2016 based onearlyresults from the DBCG PBI trial.During trial accrual, respiratory-gated radiotherapy was introduced in Denmark. This study aims to investigate the effect of respiratory-gating on mean heart dose (MHD). PATIENTS AND METHODS: From 2009 to 2016 the DBCG PBI trial included 230 patientswith left-sided breast cancer receiving external beam PBI, 40 Gy/15 fractions/3 weeks.Localization of the tumor bed on the planning CT scan, the use of respiratory-gating, coverage of the clinical target volume (CTV), and doses to organs at risk were collected. RESULTS: Respiratory-gating was used in 123 patients (53 %). In 176 patients (77 %) the tumor bed was in the upper and in 54 patients (23 %) in the lower breast quadrants. The median MHD was 0.37 Gy (interquartile range 0.26-0.57 Gy), 0.33 Gy (0.23-0.49 Gy) for respiratory-gating, and 0.49 Gy (0.31-0.70 Gy) for free breathing, p < 0.0001. MHD was < 1 Gy in 206 patients (90 %) and < 2 Gy in 221 patients (96 %). Respiratory-gating led to significantly lower MHD for upper-located, but not for lower-located tumor beds, however, all MHD were low irrespective of respiratory-gating. Respiratory-gating did not improve CTV coverage or lower lung doses. CONCLUSIONS: PBI ensured a low MHD for most patients. Adding respiratory-gating further reduced MHD for upper-located but not for lower-located tumor beds but did not influence target coverage or lung doses. Respiratory-gating is no longer DBCG standard for left-sided PBI.
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Órganos en Riesgo , Humanos , Femenino , Persona de Mediana Edad , Órganos en Riesgo/efectos de la radiación , Dinamarca , Anciano , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/patología , Neoplasias de Mama Unilaterales/radioterapia , Dosificación Radioterapéutica , Corazón/efectos de la radiación , Planificación de la Radioterapia Asistida por Computador/métodos , Técnicas de Imagen Sincronizada Respiratorias/métodos , AdultoRESUMEN
BACKGROUND: Concurrent chronic diseases and treatment hereof in patients with cancer may increase mortality. In this population-based study we examined the individual and combined impact of multimorbidity and polypharmacy on mortality, across 20 cancers and with 13-years follow-up in Denmark. MATERIALS AND METHODS: This nationwide study included all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015, and followed until the end of 2017. We defined multimorbidity as having one or more of 20 chronic conditions in addition to cancer, registered in the five years preceding diagnosis, and polypharmacy as five or more redeemed medications 2-12 months prior to cancer diagnosis. Cox regression analyses were used to estimate the effects of multimorbidity and polypharmacy, as well as the combined effect on mortality. RESULTS: A total of 261,745 cancer patients were included. We found that patients diagnosed with breast, prostate, colon, rectal, oropharynx, bladder, uterine and cervical cancer, malignant melanoma, Non-Hodgkin lymphoma, and leukemia had higher mortality when the cancer diagnosis was accompanied by multimorbidity and polypharmacy, while in patients with cancer of the lung, esophagus, stomach, liver, pancreas, kidney, ovarian and brain & central nervous system, these factors had less impact on mortality. CONCLUSION: We found that multimorbidity and polypharmacy was associated with higher mortality in patients diagnosed with cancer types that typically have a favorable prognosis compared with patients without multimorbidity and polypharmacy. Multimorbidity and polypharmacy had less impact on mortality in cancers that typically have a poor prognosis.
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Melanoma , Multimorbilidad , Masculino , Humanos , Estudios de Cohortes , Polifarmacia , Enfermedad Crónica , Sistema de Registros , Dinamarca/epidemiologíaRESUMEN
Biochar is a product rich in carbon produced by pyrolysis of different kinds of biomass and it modifies the physical, chemical, and biological properties of soil. In this study, biochar, produced at different pyrolysis temperatures (590 °C, 665 °C, and 765 °C), was physico-chemically characterized. It was explored whether biochar made from sewage sludge can become an alternative solution for future water and phosphorus management in agricultural production. A pot experiment was conducted using Chinese cabbage (Brassica rapa subsp. pekinensis) to investigate the effect of applying different biochars to the substrate, taking into account different growth parameters and the biochemical composition of the plants, as well as the physico-chemical properties of the substrate. According to the results, pyrolysis temperature influences the content of elements in biochar and their availability to plants, with total phosphorus contents in biochar ranging from 4.6% to 4.9%. In addition, applying biochar to the substrate significantly increases the volumetric water content up to 4.5 fold more compared to the control, which indicates a promising application in drought stress conditions and, at the same time, is a source of nutrients and can help to reduce the amount of mineral fertilizer application.
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Carbón Orgánico , Aguas del Alcantarillado , Aguas del Alcantarillado/química , Carbón Orgánico/química , Suelo/química , Agua/química , Fósforo/químicaRESUMEN
Despite public health risk mitigation measures and regulation efforts by many countries, regions, and sectors, viral outbreaks remind the world of our vulnerability to biological hazards and the importance of mitigation actions. The saltwater-tolerant plants in the Salicornia genus belonging to the Amaranthaceae family are widely recognized and researched as producers of clinically applicable phytochemicals. The plants in the Salicornia genus contain flavonoids, flavonoid glycosides, and hydroxycinnamic acids, including caffeic acid, ferulic acid, chlorogenic acid, apigenin, kaempferol, quercetin, isorhamnetin, myricetin, isoquercitrin, and myricitrin, which have all been shown to support the antiviral, virucidal, and symptom-suppressing activities. Their potential pharmacological usefulness as therapeutic medicine against viral infections has been suggested in many studies, where recent studies suggest these phenolic compounds may have pharmacological potential as therapeutic medicine against viral infections. This study reviews the antiviral effects, the mechanisms of action, and the potential as antiviral agents of the aforementioned phenolic compounds found in Salicornia spp. against an influenza A strain (H1N1), hepatitis B and C (HBV/HCV), and human immunodeficiency virus 1 (HIV-1), as no other literature has described these effects from the Salicornia genus at the time of publication. This review has the potential to have a significant societal impact by proposing the development of new antiviral nutraceuticals and pharmaceuticals derived from phenolic-rich formulations found in the edible Salicornia spp. These formulations could be utilized as a novel strategy by which to combat viral pandemics caused by H1N1, HBV, HCV, and HIV-1. The findings of this review indicate that isoquercitrin, myricetin, and myricitrin from Salicornia spp. have the potential to exhibit high efficiency in inhibiting viral infections. Myricetin exhibits inhibition of H1N1 plaque formation and reverse transcriptase, as well as integrase integration and cleavage. Isoquercitrin shows excellent neuraminidase inhibition. Myricitrin inhibits HIV-1 in infected cells. Extracts of biomass in the Salicornia genus could contribute to the development of more effective and efficient measures against viral infections and, ultimately, improve public health.
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Infecciones por VIH , VIH-1 , Hepatitis C , Subtipo H1N1 del Virus de la Influenza A , Virosis , Humanos , Virus de la Hepatitis B , Antivirales/farmacología , Antivirales/uso terapéutico , Antivirales/química , Virosis/tratamiento farmacológico , Fenoles/farmacología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Hepatitis C/tratamiento farmacológicoRESUMEN
Bioactive extracts are often the target fractions in bioprospecting, and halophyte plants could provide a potential source of feedstock for high-value applications as a part of integrated biorefineries. Tripolium pannonicum (Jacq.) Dobrocz. (sea aster) and Crithmum maritimum L. (sea fennel) are edible plants suggested for biosaline halophyte-based agriculture. After food production and harvesting of fresh leaves for food, the inedible plant fractions could be utilized to produce extracts rich in bioactive phytochemicals to maximize feedstock application and increase the economic feasibility of biomass processing to bioenergy. This study analyzed fresh juice and extracts from screw-pressed sea aster and sea fennel for their different phenolic compounds and pigment concentrations. Antioxidant and enzyme inhibition activities were also tested in vitro. Extracts from sea aster and sea fennel had phenolic contents up to 45.2 mgGAE/gDM and 64.7 mgGAE/gDM, respectively, and exhibited >70% antioxidant activity in several assays. Ethanol extracts also showed >70% inhibition activity against acetylcholinesterase and >50% inhibition of tyrosinase and α-glucosidase. Therefore, these species can be seen as potential feedstocks for further investigations.
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Apiaceae , Plantas Tolerantes a la Sal , Biomasa , Extractos Vegetales/farmacología , Extractos Vegetales/química , Acetilcolinesterasa , Antioxidantes/farmacología , Antioxidantes/química , Apiaceae/química , Fenoles/farmacología , Fenoles/análisisRESUMEN
BACKGROUND: People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. METHODS: We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. FINDINGS: Of 2â036â704 people who were invited, we included 2â036â352 in the final cohort, of whom 1â008â045 (49·5%) were men and 1â028â307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. INTERPRETATION: People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. FUNDING: Danish Cancer Society, Danish Health Foundation.
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Colonoscopía , Neoplasias Colorrectales , Tamizaje Masivo , Trastornos Mentales , Participación del Paciente , Dinamarca/epidemiología , Estudios de Cohortes , Trastornos Mentales/clasificación , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/mortalidad , Incidencia , Tamizaje Masivo/psicología , Tamizaje Masivo/estadística & datos numéricos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Colonoscopía/psicología , Colonoscopía/estadística & datos numéricos , Participación del Paciente/psicología , Participación del Paciente/estadística & datos numéricos , Sistema de Registros , Datos de Salud Recolectados Rutinariamente , Pronóstico , Factores de Confusión EpidemiológicosRESUMEN
The fecal immunochemical test (FIT) has been implemented in colorectal cancer (CRC) screening programs, but effect evaluations are lacking. We evaluated the effect of a positive FIT on all-cause and CRC mortality using the regression discontinuity design. The Danish CRC screening program invites all residents 50-74 years old, using a 20-µg hemoglobin/g feces cutoff for colonoscopy referral. In this cohort study, we followed all first-time screening participants from 2014-2019 until 2020. We estimated the local effect of screening results, of just above the cutoff vs. just below, as hazard ratios (HRs) between models fitted at each side of the cutoff. We conducted the analysis within a narrow hemoglobin range (≥17 and <23, n = 16,428) and a wider range (≥14 and <26, n = 35,353). Those screened just above the cutoff had lower all-cause mortality compared with below (HR = 0.87, 95% confidence interval: 0.69; 1.10), estimated from the narrow range. The CRC mortality analysis had few outcomes. In the wider range, those with a FIT just above the cutoff had a lower hazard of CRC mortality compared with just below the cutoff (HR = 0.49, 95% confidence interval: 0.17; 1.41). A FIT result just above the cutoff, leading to referral to colonoscopy, pointed towards reduced all-cause and CRC mortality compared with just below the cutoff.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Humanos , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Detección Precoz del Cáncer/métodos , Neoplasias Colorrectales/diagnóstico , Hemoglobinas/análisis , Sangre OcultaRESUMEN
Salt-tolerant plants, also known as halophytes, could provide a novel source of feedstock for biorefineries. After harvesting fresh shoots for food, the lignified fraction of Salicornia ramosissima J. Woods could be used to produce bioactive botanical extracts for high-value industries such as nutraceuticals, cosmetics, and biopharmaceuticals. The residual fraction after extraction can be further used for bioenergy or lignocellulose-derived platform chemicals. This work analysed S. ramosissima from different sources and growth stages. After pre-processing and extractions, the obtained fractions were analysed for their contents of fatty acids, pigments, and total phenolics. Extracts were also evaluated for their in vitro antioxidant properties and inhibitory effect towards enzymes related to diabetes, hyperpigmentation, obesity, and neurogenerative diseases. The ethanol extract from the fibre residue and the water extract from completely lignified plants showed the highest concentration of phenolic compounds along with the highest antioxidant potential and enzyme-inhibitory properties. Hence, they should be further explored in the context of biorefinery.
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Polyphenols from residual non-food grade Salicornia ramosissima have health-promoting effects in feed, food, or nutraceutical applications. Therefore, the isolation of polyphenols is of interest from a series of environmentally friendly isolation methods with recyclable solvents. The isolation of polyphenols from non-food grade S. ramosissima was investigated using sequential membrane filtration with and without acid pretreatment, liquid-liquid extraction, resin adsorption, and centrifugal partition chromatography (CPC); analyzed by the Folin-Ciocalteu assay for total polyphenols; and finally analyzed using UPLC-TQMS in negative ion-spray mode for detection of 14 polyphenols. Sequential membrane filtration and acid hydrolysis indicated the polyphenols forming complexes with other compounds, retaining the polyphenols in the retentate fraction of large molecular weight cut-off membrane sizes. Conventional liquid-liquid extraction using sequential ethyl acetate and n-butanol showed most polyphenols were extracted, apart from chlorogenic acids, indicating a low isolation efficiency of higher polarity polyphenols. Analysis of the extract after resin adsorption by Amberlite XAD-4 resin showed high efficiency for separation, with 100% of polyphenols adsorbed to the resin after 13 bed volumes and 96.7% eluted from the resin using ethanol. CPC fractionations were performed to fractionate the concentrated extract after resin adsorption. CPC fractionations of the 14 polyphenols were performed using an organic or aqueous phase as a mobile phase. Depending on the mobile phase, different compounds were isolated in a high concentration. Using these easily scalable methods, it was possible to comprehensively study the polyphenols of interest from S. ramosissima and their isolation mechanics. This study will potentially lead the way for the large-scale isolation of polyphenols from S. ramosissima and other complex halophytes. The compounds of the highest concentration after CPC fractionation were isoquercitrin and hyperoside (155.27 mg/g), chlorogenic acid (85.54 mg/g), cryptochlorogenic acid (101.50 mg/g), and protocatechuic acid (398.67 mg/g), and further isolation using CPC could potentially yield novel polyphenol nutraceuticals.
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Chenopodiaceae , Polifenoles , Plantas Tolerantes a la Sal , Ácido Clorogénico , SolventesRESUMEN
Salt-tolerant halophytes have shown potential for biorefinery and agricultural use in salt-affected soils, increasing the value of marginal lands. They could provide a bio-based source for compounds obtained from the petrochemical industry or an alternative for biomass currently imported overseas. Salicornia europaea, Tripolium pannonicum and Crithmum maritimum were cultivated in hydroponic systems under various salinity conditions, harvested green but not food-grade, and fractionated to green juice and fibre residue. Obtained fractions were characterised for contents of carbohydrates, Klason lignin, crude protein, organic acids, lipids, and minerals to evaluate the biomass' suitability for biorefinery. Significant differences were observed in the biomass yield and the composition of the biomass fractions from different cultivation salinities. High concentrations of crude protein were found. Thus, these species could have the potential for green protein production. Fractions rich in carbohydrates could be used for lignocellulose processing and processes utilising micro-organisms.
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Apiaceae , Asteraceae , Chenopodiaceae , Biomasa , Fibras de la DietaRESUMEN
There is an increased interest in identifying beneficial compounds of plant origin that can be added to animal diets to improve animal performance and have a health-promoting effect. In the present study, nine herb species of the Norwegian wild flora or which can be cultivated in Norway were selected for phytogenic evaluation (hops, maral root, mint, oregano, purslane, rosemary, roseroot, sweet wormwood, yarrow). Dried herbs were sequentially extracted with dichloromethane (DCM), ethanol (EtOH) and finally water (H2O) by ultrasound-assisted extraction (UAE). The UAE protocol was found to be more rational than conventional Soxhlet with respect to DCM extraction. Total extraction yield was found to be highest for oregano (Origanum vulgare) with 34.4 g 100-1 g dry matter (DM). H2O-extracts gave the highest yields of the three solvents, with up to 25 g 100-1 g DM for purslane (Portulaca oleracea ssp. sativa) and mint (Mentha piperita). EtOH- and H2O-extracts were the most efficient extracts with respect to free radical scavenging capacity (ABTS (=2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid), and oregano, mint, hops (Humulus lupulus) and maral root-leaves (Leuzea carthamoides) were found to be the most efficient antioxidant sources. Hops (EtOH-extract) contained α- and ß-acids, xanthohumols, chlorogenic acid and the hitherto unreported 3-O-glucosides of kaempferol and quercetin. Maral root-leaves contained among other compounds hexosides of the 6-hydroxy- and 6-methoxy-kaempferol and -quercetin, whereas roseroot (Rosea rhodiola) revealed contents of rosavin, rhodiosin and rhodionin. Sweet wormwood (Artemisia annua) contained chlorogenic acid and several derivatives thereof, scopoletin and poly-methylated flavones (eupatin, casticin, chrysoplenetin). Antimicrobial potential of different plant extracts was demonstrated against Gram-positive and Gram-negative bacteria using the indicator organisms Staphylococcus aureus, and Escherichia coli, and the Atlantic salmon bacterial pathogens Moritella viscosa, Tenacibaculum finnmarkense and Aliivibrio wodanis. DCM extracts possessed the highest activities. Data demonstrate the potential ability of herb extracts as natural antimicrobials. However, future safety studies should be performed to elucidate any compromising effect on fish health.
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Artemisia annua , Origanum , Rhodiola , Quempferoles , Antibacterianos/farmacología , Antibacterianos/química , Quercetina , Ácido Clorogénico , Bacterias Gramnegativas , Bacterias Grampositivas , Extractos Vegetales/farmacología , Extractos Vegetales/química , Origanum/química , Antioxidantes/farmacología , Antioxidantes/química , Rhodiola/químicaRESUMEN
This paper examines how the central contributions of the computational design field can be understood as central steppingstones into an age of sustainability to engage with new renewable, regenerative and restorative material systems. By taking departure in the conceptualisation of an extended digital chain by which architecture can address fabrication at the low scales of the material, this paper asks how these methodological innovations can be transferred to new questions arising from a bio-based material paradigm. The paper outlines the three central contributions of the computational design field: advanced information modelling, functional grading and integrated sensing, and suggests how these can be extended to allow new means of instrumentation for bio-based materials characterised by the heterogeneous, the behaving and the living.
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PURPOSE: The relation between breast induration grade 2-3 at 3 years after radiation therapy and irradiated breast volume was investigated for patients in the Danish Breast Cancer Group (DBCG) Partial Breast Irradiation (PBI) trial. METHODS Treatment plan data was obtained from the Danish radiotherapy plan database. Dosimetric parameters for breast and organs at risk were determined. Breast induration data was obtained from the DBCG database. The volume of the whole breast (CTVp_breast) treated to various dose levels was determined for treatment plans in both arms. Logistic regression was used to assess the frequency of induration on breast volume irradiated to ≥40 Gy. RESULTS PBI and WBI was given to 433 and 432 patients, respectively. Median and interquartile ranges (IQR) for CTVp_breast were 710 mL (467-963 mL; PBI) and 666 mL (443-1012 mL; WBI) (p = 0.98). Median and IQR for CTVp_breast treated to ≥40 Gy was 24.9% (18.6-32.6%; PBI) and 59.8% (53.6-68.5%; WBI). Grade 2-3 induration was observed in 5% (PBI) and 10% (WBI) of the patients. A dose-response relationship was established between irradiated breast volume and frequency of breast induration. From the model, 5% and 10% risks of breast induration were observed for ≥40 Gy delivered to CTVp_breast volumes of 177 mL (95%CI, 94-260 mL) and 426 mL (95%CI, 286-567 mL), respectively. CONCLUSION The frequency of breast induration increased significantly with increasing irradiated breast volume, strongly favouring small volumes and PBI. Thus, treated breast volume - not the breast size itself - is the risk factor for induration. This is the first report directly linking the 40 Gy irradiated breast volume to breast induration.
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Neoplasias de la Mama , Femenino , Humanos , Mama/efectos de la radiación , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Dinamarca , Mastectomía Segmentaria , RadiometríaRESUMEN
Objective.Radiotherapy of left-sided breast cancer in deep inspiration breath-hold (DIBH) reduces the heart dose. Surface guided radiotherapy (SGRT) can guide the DIBH, but the accuracy is subject to variations in the chest wall position relative to the patient surface.Approach.In this study, ten left-sided breast cancer patients received DIBH radiotherapy with tangential fields in 15-18 fractions. After initial SGRT setup in free breathing an orthogonal MV/kV image pair was acquired during SGRT-guided breath-hold. The couch was corrected to align the chest wall during another breath-hold, and a new SGRT reference surface was acquired for the gating. The chest wall position error during treatment was determined from continuous cine MV images in the imager direction perpendicular to the cranio-caudal direction. A treatment error budget was made with individual contributions from the online registration of the setup MV image, the difference in breath-hold level between setup imaging and SGRT reference surface acquisition, the SGRT level during treatment, and intra-fraction shifts of the chest wall relative to the SGRT reference surface. In addition to the original setup protocol (Scenario A), SGRT was also simulated with better integration of image-guidance by capturing either the new reference surface (Scenario B) or the SGRT positional signal (Scenario C) simultaneously with the setup MV image, and accounting for the image-guided couch correction by shifting the SGRT reference surface digitally.Main results.In general, the external SGRT signal correlated well with the internal chest wall position error (correlation coefficient >0.7 for 75% of field deliveries), but external-to-internal target position offsets above 2 mm occasionally occurred (13% of fractions). The PTV margin required to account for the treatment error was 3.5 mm (Scenario A), 3.4 mm (B), and 3.1 mm (C).Significance. Further integration of SGRT with image-guidance may improve treatment accuracy and workflow although the current study did not show large accuracy improvements of scenario B and C compared to scenario A.
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Neoplasias de la Mama , Radioterapia Guiada por Imagen , Neoplasias de Mama Unilaterales , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/radioterapia , Contencion de la Respiración , Femenino , Humanos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Guiada por Imagen/métodos , Neoplasias de Mama Unilaterales/diagnóstico por imagen , Neoplasias de Mama Unilaterales/radioterapiaRESUMEN
PURPOSE: On the basis of low risk of local recurrence in elderly patients with breast cancer after conservative surgery followed by whole breast irradiation (WBI), the Danish Breast Cancer Group initiated the noninferiority external-beam partial breast irradiation (PBI) trial (ClinicalTrials.gov identifier: NCT00892814). We hypothesized that PBI was noninferior to WBI regarding breast induration. METHODS: Patients operated with breast conservation for relatively low-risk breast cancer were randomly assigned to WBI versus PBI, and all had 40 Gy/15 fractions. The primary end point was 3-year grade 2-3 breast induration. RESULTS: In total, 865 evaluable patients (434 WBI and 431 PBI) were enrolled between 2009 and 2016. Median follow-up was 5.0 years (morbidity) and 7.6 years (locoregional recurrence). The 3-year rate of induration was 9.7% for WBI and 5.1% for PBI (P = .014). Large breast size was significantly associated with induration with a 3-year incidence of 13% (WBI) and 6% (PBI) for large-breasted patients versus 6% (WBI) and 5% (PBI) for small-breasted patients. PBI showed no increased risk of dyspigmentation, telangiectasia, edema, or pain, and patient satisfaction was high. Letrozole and smoking did not increase the risk of radiation-associated morbidity. Sixteen patients had a locoregional recurrence (six WBI and 10 PBI; P = .28), 20 patients had a contralateral breast cancer, and eight patients had distant failure (five WBI and three PBI). A nonbreast second cancer was detected in 73 patients (8.4%), and there was no difference between groups. CONCLUSION: External-beam PBI for patients with low-risk breast cancer was noninferior to WBI in terms of breast induration. Large breast size was a risk factor for radiation-associated induration. Few recurrences were detected and unrelated to PBI.
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Neoplasias de la Mama , Humanos , Anciano , Femenino , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/cirugía , Mama/efectos de la radiación , Dinamarca/epidemiología , Mastectomía SegmentariaRESUMEN
INTRODUCTION: Compared with the background population, persons with mental illness have increased colorectal cancer (CRC) mortality. Screening has the potential to alleviate the increased cancer mortality due to mental illness, but the extent to which persons with mental illness participate in CRC screening programs is uncertain. This scoping review aims to summarize the literature on CRC screening participation among persons with mental illness. MATERIALS AND METHODS: We searched four databases (PubMed, PsychInfo, Embase, and the Cochrane Library) to identify published literature on mental illness and participation in CRC screening programs. We included full-text papers available in English, published before February 2021, and excluded papers on dementia, intellectual disabilities, and developmental disabilities. RESULTS: In total, we included 17 studies and categorized the findings according to severity of mental illness. Across varying study designs, the studies found that persons with severe mental illness, e.g. schizophrenia, participate less in CRC screening compared with the background population. The results were ambiguous for common mental illness, such as depression and anxiety. In general, studies were small or lacked comparison groups and the estimates were imprecise. CONCLUSION: This is the first scoping review to evaluate participation in CRC screening programs among persons with mental illness. Overall, the existing literature lacks high quality evidence from large population-based studies and comparison groups based on organized screening programs.
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Neoplasias Colorrectales , Trastornos Mentales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer , Humanos , Tamizaje Masivo , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Proyectos de InvestigaciónRESUMEN
This paper discusses the foundations of a bio-based material paradigm for architecture. It argues that moving from a current reliance on the non-renewable materials of the geosphere, to the renewable and fundamentally cyclical materials of the biosphere can establish alternate foundations for thinking alternative sustainable building practices. By positioning architecture and the built environment as a particular case for bio-based materials, where the longer life spans of buildings support better carbon storage, this paper identifies the bottlenecks that limit their adaptation into the way architecture is thought, designed and built. If architectural ideation and design is traditionally understood through the durable and the permanent, our aim here is to challenge this foundation and bring forth the fundamental differences that bio-based materials engender. With focus on the embedded lifespans of living materials, the fundamental circularity and degradability of biomass and resulting transformative life cycles of the artefacts that they embody, this paper asks how a new representational framework for bio-based material paradigm can be conceptualised, instrumentalised and in turn materialised. The paper supports this positioning through a presentation of a series of methodological probes. The probes outline strategies for new methodologies by which we can capture, predict and steer the transformations of living materials and functionalise them as part of an architectural performance.
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BiomasaRESUMEN
Halophyte plants are salt-tolerant and are acclimated for growth in saline soils such as along coastal areas. Among the halophytes, the Salicornia species have been used as both folk medicine and functional food for many years due to their high levels of bioactive compounds with supposed anti-inflammatory and antioxidative effects. However, the properties of Salicornia bioactive extracts on pain and itching still remain unclear. In this study, 30 healthy volunteers were randomized to treatments with 10% Salicornia-based cream or placebo cream for 24 or 48 h. On day 0, and 24 or 48 h post cream application, cold/heat detection and pain thresholds, mechanical pain thresholds and sensitivity, trans-epidermal water loss, histamine- and cowhage-evoked itch, and micro-vascular reactivity (neurogenic inflammation) were assessed to evaluate the analgesic, anti-pruritogenic and vasomotor effects. Skin permeability was reduced in the Salicornia-treated area for 48 h compared with 24 h application (p-value < 0.05). After 48 h of application, a decrease in mechanical-evoked itching (hyperkinesis) compared with 24 h treatment (p-value < 0.05) and increased warm detection and heat pain thresholds (p-value < 0.05) was found. Histamine-induced neurogenic inflammation showed a significant reduction in the cream-treated areas after 48 h compared with 24 h (p-value < 0.05). The results of this study indicate the overall inhibitory effect of Salicornia on hyperkinesis (mechanically evoked itch), the analgesic effect on thermal sensation, and modulation of the skin barrier architecture. Further studies are needed for the assessment of the long-term effects.