Chornobyl radiation spikes are not due to military vehicles disturbing soil.

On 25th February 2022, increased gamma radiation dose rates were reported within the Chornobyl Exclusion Zone (CEZ). This coincided with Russian military vehicles entering the Ukrainian part of the CEZ from neighbouring Belarus. It was speculated that contaminated soil resuspension by vehicle movements or a leak from the Chornobyl Nuclear Power Plant complex may explain these spikes in radiation dose rates. The gamma dose rate monitoring network in the CEZ provides a crucial early warning system for releases of radioactivity to the environment and is part of the international safeguards for nuclear facilities. With the potential for further military action in the CEZ and concerns over nuclear safety, it is essential that such anomalous readings are investigated. We evaluate the hypotheses suggested to explain the apparent gamma dose rate increases, demonstrating that neither military vehicle-induced soil resuspension nor a leak from the Chornobyl Nuclear Power Plant are plausible. However, disruption of the Chornobyl base-station's reception of wireless signals from the gamma dose rate monitoring network in the CEZ may potentially explain the dose rate increases recorded.

Spring-mass behavioural adaptations to acute changes in prosthetic blade stiffness during submaximal running in unilateral transtibial prosthesis users.

BACKGROUND: Individuals with lower-limb amputation can use running specific prostheses (RSP) that store and then return elastic energy during stance. However, it is unclear whether varying the stiffness category of the same RSP affects spring-mass behaviour during self-selected, submaximal speed running in individuals with unilateral transtibial amputation. RESEARCH QUESTION: The current study investigates how varying RSP stiffness affects limb stiffness, running performance, and associated joint kinetics in individuals with a unilateral transtibial amputation. METHODS: Kinematic and ground reaction force data were collected from eight males with unilateral transtibial amputation who ran at self-selected submaximal speeds along a 15 m runway in three RSP stiffness conditions; recommended habitual stiffness (HAB) and, following 10-minutes of familiarisation, stiffness categories above (+1) and below (-1) the HAB. Stance-phase centre of mass velocity, contact time, limb stiffness' and joint/RSP work were computed for each limb across RSP stiffness conditions. RESULTS: With increased RSP stiffness, prosthetic limb stiffness increased, whilst intact limb stiffness decreased slightly (p<0.03). Centre of mass forward velocity during stance-phase (p<0.02) and contact time (p<0.04) were higher in the intact limb and lower in the prosthetic limb but were unaffected by RSP stiffness. Intact limb hip joint positive work increased for both the +1 and -1 conditions but remained unchanged across conditions in the prosthetic limb (p<0.02). SIGNIFICANCE: In response to changes in RSP stiffness, there were acute increased mechanical demands on the intact limb, reflecting a reliance on the intact limb during running. However, overall running speed was unaffected, suggesting participants acutely adapted to an RSP of a non-prescribed stiffness.

Ensuring robust radiological risk assessment for wildlife: insights from the International Atomic Energy Agency EMRAS and MODARIA programmes.

In response to changing international recommendations and national requirements, a number of assessment approaches, and associated tools and models, have been developed over the last circa 20 years to assess radiological risk to wildlife. In this paper, we summarise international intercomparison exercises and scenario applications of available radiological assessment models for wildlife to aid future model users and those such as regulators who interpret assessments. Through our studies, we have assessed the fitness for purpose of various models and tools, identified the major sources of uncertainty and made recommendations on how the models and tools can best be applied to suit the purposes of an assessment. We conclude that the commonly used tiered or graded assessment tools are generally fit for purpose for conducting screening-level assessments of radiological impacts to wildlife. Radiological protection of the environment (or wildlife) is still a relatively new development within the overall system of radiation protection and environmental assessment approaches are continuing to develop. Given that some new/developing approaches differ considerably from the more established models/tools and there is an increasing international interest in developing approaches that support the effective regulation of multiple stressors (including radiation), we recommend the continuation of coordinated international programmes for model development, intercomparison and scenario testing.

A cross-sectional study of gender differences in quality of life domains in patients with neurofibromatosis type 1.

BACKGROUND: There is limited data regarding gender differences in quality of life between women and men with Neurofibromatosis type 1. We aimed to study differences in quality of life domains between women and men with Neurofibromatosis type 1 living in Canada. METHODS: This is a cross sectional study of adults with Neurofibromatosis type 1 attending a tertiary NF centre at Toronto General Hospital between January 2016 to December 2017. Demographic and clinical data were collected. We compared scores of generic measures (SF-36, EQ-5D-5L, pain interference) and a disease-specific measure (PedsQL-NF1 module) between women and men. We also assessed the relationship between disease visibility scored by an examiner (Ablon's visibility index) and self-reported perceived physical appearance, stratified by gender. RESULTS: One hundred and sixty-two participants were enrolled, 92 females and 70 males. Ablon's index score 1 was in 43% and score 2 in 44%, while only 13% of patients had a score 3. Women had worse scores on the total PedsQL-NF1 scales, and also in the perceived physical appearance, anxiety and emotional health domains. In women, there was a low but significant correlation between Ablon's index and perceived physical appearance (r = - 0.27, p = 0.01, ANOVA p < 0.001). In men, there was no difference in self-reported physical appearance by Ablon's index. There were no differences between men and women in the SF-36 or EQ-5D-5L scores. CONCLUSION: Women with NF1 reported worse NF1-related quality of life than men, with worse perceived physical appearance, anxiety, and mental health. Perceived physical appearance does not always correlate to disease visibility; therefore, healthcare providers should inquire about body image, physical appearance concerns, and mental health, especially among women with NF1.

Avian predators taste reject mimetic prey in relation to their signal reliability.

Aposematic organisms defend themselves through various means to increase their unprofitability to predators which they advertise with conspicuous warning signals. Predators learn to avoid aposematic prey through associative learning that leads to lower predation. However, when these visual signals become unreliable (e.g., through automimicry or Batesian mimicry), predators may switch from using visual signals to taste sampling prey to choose among them. In this experiment, we tested this possibility in a field experiment where we released a total of 4800 mealworm prey in two clusters consisting of either: (i) undefended prey (injected with water) and (ii) model-mimics (injected with either quinine sulphate [models] or water [mimics]). Prey were deployed at 12 sites, with the mimic frequency of the model-mimics ranging between 0 and 1 (at 0.2 intervals). We found that taste rejection peaked at moderate mimic frequencies (0.4 and 0.6), supporting the idea that taste sampling and rejection of prey is related to signal reliability and predator uncertainty. This is the first time that taste-rejection has been shown to be related to the reliability of prey signals in a mimetic prey system.

Chronic immunoglobulin maintenance therapy in myasthenia gravis.

BACKGROUND AND PURPOSE: Long-term treatment of myasthenia gravis (MG) includes symptomatic and course-modifying therapies that target the immune system. Recently, both intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) have emerged as viable options for chronic therapy, considering the favourable safety-efficacy profile and possible immunosuppressant sparing properties. The aim was to investigate the outcomes of the long-term care of generalized MG with immunoglobulin (Ig). METHODS: This is a retrospective, repeated-measures design study. Charts of generalized MG patients, treated with IVIG/SCIG for at least 6 months, from January 2015 to January 2020, were analysed. The primary outcome was the mean change in Myasthenia Gravis Impairment Index (MGII) after treatment with Ig, comparing baseline to IVIG and SCIG treatment periods. Secondary outcomes included the changes in pyridostigmine, immunosuppressive medications and patient-reported outcome 'percentage of normal' (0%-100%). RESULTS: Thirty-four patients were treated with chronic Ig therapy (30 IVIG/SCIG, three SCIG, one IVIG). The mean durations of IVIG and SCIG periods were 21.8 ± 19.4 (range 3-64) months and 19.5 ± 11.3 (range 5-45) months respectively. There was a significant reduction in MGII scores (27.7 ± 15.7 baseline; 22.0 ± 17.4 IVIG period; 19.5 ± 18.1 SCIG period; F = 17.9; d.f. = 1.7; P < 0.01), pyridostigmine and immunosuppressant use (P = 0.00). The outcome 'percentage of normal' had a significant positive association with both treatments (P = 0.00). CONCLUSION: Our study results suggest that patients can be successfully transitioned to IVIG and from IVIG to SCIG in the chronic treatment of generalized MG with reductions in impairments and use of other medications and improvement in overall status with Ig therapy. Prospective, randomized studies are needed to clarify costs and comparative effectiveness.

Comparison of the single simple question and the patient acceptable symptom state in myasthenia gravis.

BACKGROUND AND PURPOSE: The single simple question (SSQ) is a simple and validated question asking what percentage of normal a patient feels with respect to their myasthenia gravis (MG), with 100% being normal. Patient acceptable symptom states (PASS) are based on a dichotomous 'Yes' or 'No' response, asking whether a patient is satisfied overall with their current status and thus measures holistic satisfaction with their MG state. Both are patient-reported self-assessments but assess different dimensions of MG. The objective was to determine thresholds for the SSQ when patients with MG achieve an acceptable PASS status. METHODS: A retrospective chart review was performed of consecutive MG patients attending a neuromuscular clinic, and SSQ and PASS responses, demographic, clinical and serological characteristics and disease severity by the MG impairment index were extracted. RESULTS: One hundred and fifty-seven consecutive patients were identified: 43 (27.4%) patients responded 'No' to the PASS question. Between the PASS 'Yes'/'No' groups, only SSQ (87.5 ± 13.4 vs. 52.3 ± 23.3; P < 0.001) and MG impairment index scores (9.2 ± 10.3 vs. 29.6 ± 16; P < 0.001) were significantly different. The receiver operating characteristic curve for PASS and SSQ had an area under the curve of 0.92 ± 0.024 (confidence interval 0.872-0.965, P < 0.001). An SSQ score ≥72.5% had 84.2% sensitivity and 86% specificity to classify patients as PASS positive. CONCLUSION: The PASS and SSQ patient-reported outcomes are closely associated and a SSQ threshold ≥72.5% predicts an acceptable MG state. Other demographic and disease-related factors did not influence the PASS response in this study.

Can models based on phylogeny be used to predict radionuclide activity concentrations in crops?

The modelling of transfer of radionuclides from soils to plants generally relies upon empirical soil-plant concentration ratios. Concentration ratios are often highly uncertain and are not available for many plant-radionuclide combinations. A number of papers published over the last 20 years have suggested that phylogenetic models could be used to make predictions of the radionuclide transfer to plants. Such a modelling approach would have the advantage that site factors (typically related to soils) are taken into account. For the first time we have compared predictions of Cs and Sr transfer to a range of crops grown on different soils. Predictions for both elements were generally acceptable (within an order of magnitude of observed data) but Sr concentrations were over predicted in fruits and tubers. This over prediction of Sr concentrations is likely to be because the phylogenetic models were fitted to data for green shoots. We conclude that phylogenetic models offer a number of advantages, but that they must be validated and, in future, parametrisation datasets need to include data on concentrations in edible plant parts and not just green shoots.

Individuals with unilateral transtibial amputation exhibit reduced accuracy and precision during a targeted stepping task.

Accurate foot placement is important for dynamic balance during activities of daily living. Disruption of sensory information and prosthetic componentry characteristics may result in increased locomotor task difficulty for individuals with lower limb amputation. This study investigated the accuracy and precision of prosthetic and intact foot placement during a targeted stepping task in individuals with unilateral transtibial amputation (IUTAs; N = 8, 47 ± 13 yrs), compared to the preferred foot of control participant's (N = 8, 33 ± 15 yrs). Participants walked along a 10-metre walkway, placing their foot into a rectangular floor-based target with dimensions normalised to a percentage of participant's foot length and width; 'standard' = 150% x 150%, 'wide' = 150% x 200%, 'long' = 200% x 150%. Foot placement accuracy (relative distance between foot and target centre), precision (between-trial variability), and foot-reach kinematics were determined for each limb and target, using three-dimensional motion capture. A significant foot-by-target interaction revealed less mediolateral foot placement accuracy for IUTAs in the wide target, which was significantly less accurate for the intact (28 ± 12 mm) compared to prosthetic foot (16 ± 14 mm). Intact peak foot velocity (4.6 ± 0.8 m.s-1) was greater than the prosthetic foot (4.5 ± 0.8 m.s-1) for all targets. Controls were more accurate and precise than IUTAs, regardless of target size. Less accurate and precise intact foot placement in IUTAs, coupled with a faster moving intact limb, is likely due to several factors including reduced proprioceptive feedback and active control during prosthetic limb single stance. This could affect activities of daily living where foot placement is critical, such as negotiating cluttered travel paths or obstacles whilst maintaining balance.

Serious infections in patients with myasthenia gravis: population-based cohort study.

BACKGROUND AND PURPOSE: To characterize the frequency and risk of serious infections in patients with myasthenia gravis (MG) relative to age/sex/area-matched comparators. METHODS: This was a population-based cohort study in Ontario, Canada of patients with newly-diagnosed MG and 1:4 age/sex/area-matched general population comparators accrued from 1 April 2002 to 31 December 2015. The main outcome was a serious infection, defined by a primary diagnosis code on a hospitalization or emergency department record. We computed crude overall and sex-specific rates of infection among patients with MG and comparators, and the frequency of specific types of infection. Adjusted hazard ratios and 95% confidence intervals were estimated using Cox regression. RESULTS: Among 3823 patients with MG, 1275 (33.4%) experienced a serious infection compared with 2973/15 292 (19.4%) of comparators over a mean follow-up of over 5 years. Crude infection rates among patients with MG were twice those in comparators (72.5 vs. 35.0 per 1000 person-years, respectively). The most common infection types were respiratory infections, particularly bacterial pneumonia. After adjustment for potential confounders, MG was associated with a 39% increased infection risk (adjusted hazard ratio, 1.39; 95% confidence intervals, 1.28-1.51). CONCLUSIONS: Patients with MG are at a significantly higher absolute and relative risk of serious infections compared with age/sex/area-matched comparators. This needs to be considered when selecting MG treatments and when planning vaccination/prophylaxis. Determining whether this risk is due to the use of immunosuppressive medications (vs. MG itself) is an important area for future research.

Vascular Resections for Pancreatic Ductal Adenocarcinoma: Vascular Resections for PDAC.

BACKGROUND AND AIMS: It has become clear that vein resection and reconstruction for pancreatic ductal adenocarcinoma (PDAC) is the standard of care as supported by multiple guidelines. However, resection of large peri-pancreatic arteries remains debatable. MATERIALS AND METHODS: This review examines the current state of vascular resection with curative intent for PDAC in the last 5 years. Herein, we consider venous (superior mesenteric vein, portal vein), as well as arterial (superior mesenteric artery, celiac trunk, hepatic artery) resection or both with or without reconstruction. RESULTS: Improvement of multidrug chemotherapy has revolutionized care for PDAC that should shift traditional surgical thinking from an anatomical classification of resectability to a prognostic and biological classification. CONCLUSION: The present review gives an overview on the results of pancreatectomy associated with vascular resection, with consideration of new perspectives offered by the availability of better systemic therapies.

Chronic stress, depression and personality type in patients with myasthenia gravis.

BACKGROUND AND PURPOSE: Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. METHODS: In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type. RESULTS: Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). CONCLUSIONS: A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.

Radionuclide transfer to wildlife at a 'Reference site' in the Chernobyl Exclusion Zone and resultant radiation exposures.

This study addresses a significant data deficiency in the developing environmental protection framework of the International Commission on Radiological Protection, namely a lack of radionuclide transfer data for some of the Reference Animals and Plants (RAPs). It is also the first study that has sampled such a wide range of species (invertebrates, plants, amphibians and small mammals) from a single terrestrial site in the Chernobyl Exclusion Zone (CEZ). Samples were collected in 2014 from the 0.4 km2 sampling site, located 5 km west of the Chernobyl Nuclear Power complex. We report radionuclide (137Cs, 90Sr, 241Am and Pu-isotopes) and stable element concentrations in wildlife and soil samples and use these to determine whole organism-soil concentration ratios and absorbed dose rates. Increasingly, stable element analyses are used to provide transfer parameters for radiological models. The study described here found that for both Cs and Sr the transfer of the stable element tended to be lower than that of the radionuclide; this is the first time that this has been demonstrated for Sr, though it is in agreement with limited evidence previously reported for Cs. Studies reporting radiation effects on wildlife in the CEZ generally relate observations to ambient dose rates determined using handheld dose meters. For the first time, we demonstrate that ambient dose rates may underestimate the actual dose rate for some organisms by more than an order of magnitude. When reporting effects studies from the CEZ, it has previously been suggested that the area has comparatively low natural background dose rates. However, on the basis of data reported here, dose rates to wildlife from natural background radionuclides within the CEZ are similar to those in many areas of Europe.

Epileptic seizure frequency and semiology in dogs with idiopathic epilepsy after initiation of imepitoin or phenobarbital monotherapy.

The aim of this study was to evaluate changes in epileptic seizures (ES) frequency and semiology in antiepileptic-medication (AEM)-naïve dogs with idiopathic epilepsy (DIE) after initiation of imepitoin (IMP) or phenobarbital (PB) monotherapy. In this observational prospective cohort study, inclusion criteria were as follows: diagnosis of idiopathic epilepsy (based on clinical, laboratory and magnetic resonance imaging investigations) in AEM-naïve dogs and presence of a detailed ES-diary. Exclusion criteria were: occurrence of cluster seizures (CS) or status epilepticus (SE) prior to treatment initiation and concurrent disease and/or treatments. Thirty-one DIE commenced IMP at 10-20mg/kg/12h and 30 dogs commenced PB at 2.50-3.30mg/kg/12h. AEM dosage was increased over time (up to IMP 30mg/kg/12h and PB 5.20mg/kg/12h). All dogs experienced generalised-tonic-clonic ES. In the IMP-group, pre-treatment median ES-frequency was 1.50ES/month (range, 1-4ES/month); post-treatment median ES-frequency was 0.95ES/m (range, 1ES/6m-3ES/m); n=21/31 (67.70%) dogs developed CS 1-18 months after initiation of treatment; n=7/31 (22.60%) dogs experienced unacceptable adverse events in the first month of treatment which required switching to an alternative AEM; and n=3/31(9.70%) dogs did not develop CS with a 3year follow-up. In the PB-group, pre-treatment median ES-frequency was 2.46ES/month (range, 1-7ES/month); post-treatment median ES-frequency was 0.36ES/month (range, 0ES/3years-1ES/month); n=11/30 (36.70%) dogs developed CS between 12-25 months after initiation of treatment. Nineteen of 30 (63.30%) dogs did not develop CS with a 3-year follow-up; three of these 19 dogs were ES free. In this study, AEM-naïve DIE receiving imepitoin-monotherapy developed CS significantly more frequently and earlier in the course of the disease, and developed aggression and required earlier discontinuation of monotherapy than AEM-naïve DIE receiving phenobarbital-monotherapy.

EQ-5D-5L and SF-6D health utility index scores in patients with myasthenia gravis.

BACKGROUND AND PURPOSE: Health utilities are a preference-based method of valuing health states that are used in healthcare research, such as economic evaluations. There are limited health utility valuation data for patients with myasthenia gravis (MG). The aim of the study was to describe health utilities for patients with MG and different health states, using the EQ-5D-5L and SF-6D utility instruments, and to explore clinical and demographic determinants of utilities in this population. METHODS: Patients completed the EQ-5D-5L and SF-6D. In addition, patients were assessed with the Myasthenia Gravis Foundation of America classification, Myasthenia Gravis Impairment Index and MG-QOL15 as disease-specific measures, and the Neuro-QoL Fatigue scale. We calculated mean utilities for each Myasthenia Gravis Foundation of America severity class. We built regression models for the EQ-5D-5L and SF-6D to determine the clinical and demographic factors that determine patients' valuation of their health state. RESULTS: Among 254 patients, mean EQ-5D-5L health utilities were as follows: Remission, 0.94 ± 0.03; Minimal Manifestations, 0.92 ± 0.04; Class I, 0.89 ± 0.06; Class II, 0.78 ± 0.16; Class III, 0.58 ± 0.24 and Class IV, 0.61 ± 0.22. Mean SF-6D health utilities were as follows: Remission, 0.83 ± 0.07; Minimal Manifestations, 0.86 ± 0.14; Class I, 0.82 ± 0.14; Class II, 0.67 ± 0.12; Class III, 0.56 ± 0.11 and Class IV, 0.50 ± 0.10. The limb/axial scores were more highly correlated to health utilities than ocular or bulbar scores. CONCLUSIONS: We present estimates of health utilities for patients with MG that can be used in cost-utility and decision analyses. Limb/axial symptoms had a higher impact on health utilities than ocular or bulbar symptoms, which might reflect the impact of mobility on health valuation.

[Pharmacological treatment compliance and a description of its associated factors in patients with myasthenia gravis]. / Adhesion al tratamiento farmacologico y descripcion de sus factores asociados en pacientes con miastenia grave.

INTRODUCTION: Medication adherence is a public health problem and this has not been previously studied in myasthenia gravis patients. AIM: To determine if patients with myasthenia gravis are adherent to treatment and to describe the clinical factors of patients who are non-adherent to treatment. PATIENTS AND METHODS: Cross-sectional study of patients with myasthenia gravis followed at Padre Hurtado Hospital, Santiago de Chile, who received their medication through the hospital and therefore were on the pharmacy's list. Patients' participation was voluntary and anonymous. Medication adherence was assessed with the Morisky-Green-Levine survey (4 items). Patients were assessed for myasthenia gravis severity with the Manual Muscle Test, and myasthenia gravis-related quality of life with the MG-QOL15. Finally, patients were screened for depression with the 12-Item General Health Questionnaire. RESULTS: 26 patients were enrolled and 15 (57.7%) were women. Only 10 (38.5%) of patients were adherent to treatment. Patients who were not adherent to medication had more weakness (p = 0.06), worse quality of life (p = 0.008), were taking a greater number of myasthenia gravis drugs (p = 0.003) and had a higher risk of depression (p = 0.03). CONCLUSIONS: In this cohort of myasthenia gravis patients, three out of five patients were not adherent to treatment. These patients tended to have more weakness, worse quality of life and higher risk of depression. Medication adherence should be assessed routinely in patients with myasthenia gravis.

TITLE: Adhesion al tratamiento farmacologico y descripcion de sus factores asociados en pacientes con miastenia grave.Introduccion. La adhesion al tratamiento farmacologico es un problema de salud publica, pero no se ha estudiado en pacientes con miastenia grave. Objetivo. Determinar la adhesion al tratamiento farmacologico en pacientes con miastenia grave y describir al grupo de pacientes no adherentes al tratamiento. Pacientes y metodos. Estudio de corte transversal, en pacientes con miastenia grave, en control y abandono del tratamiento farmacologico en el Hospital Padre Hurtado, Santiago de Chile. Los pacientes fueron invitados a participar de forma voluntaria y anonima. Se evaluo la adhesion al tratamiento con la escala Morisky-Green-Levine de cuatro items. Ademas, se evaluo la gravedad de la miastenia grave con el test manual de fuerza muscular (MMT); la calidad de vida asociada a la miastenia grave, con el 15-Item Quality Of Life Instrument for Myasthenia Gravis (MG-QOL15), y el riesgo de depresion, con el cuestionario de salud general de 12 items (GHQ-12). Resultados. Participaron 26 pacientes, de los cuales 15 (57,7%) eran mujeres. Solo 10 (38,5%) mostraron adhesion al tratamiento. Los no adherentes presentaron mayor debilidad (MMT; p = 0,06) y peor calidad de vida (MG-QOL15; p = 0,008), y tomaban mas farmacos para la miastenia grave (p = 0,003). Ademas, presentaron mayor riesgo de depresion (GHQ-12; p = 0,03) comparados con el grupo de adhesion al tratamiento. Conclusion. Tres de cada cinco pacientes con miastenia grave abandonaron el tratamiento, lo que se asocio con mayor debilidad, peor calidad de vida y mayor riesgo de depresion. Por lo tanto, deberia evaluarse la adhesion al tratamiento en los pacientes con miastenia grave.

Toronto Clinical Neuropathy Score is valid for a wide spectrum of polyneuropathies.

BACKGROUND AND PURPOSE: The Toronto Clinical Neuropathy Score (TCNS) is a valid and reliable scale for the diagnosis and staging of diabetic sensorimotor polyneuropathy. In this study, we aimed to explore the performance of the TCNS in non-diabetic polyneuropathies. METHODS: We performed a prospective study from November 2016 to May 2017 of patients with non-diabetic polyneuropathy. Patients had clinical, electrophysiological and functional assessments of their polyneuropathy, and the findings were correlated with the TCNS. RESULTS: The TCNS correlated with all clinical, electrophysiological and disability measures of polyneuropathy, mostly at a moderate level (e.g. r = -0.58 for sural nerve action potential amplitude). Higher TCNS severity grades were associated with worse polyneuropathy on all measures in the lower limbs, and with worse electrophysiological parameters and vibration perception thresholds in the upper limbs. The scale also showed excellent reliability and accuracy (kappa, 0.92-0.93 for inter- and intra-observer reliability; area under the receiver operating characteristics curve, 0.93). CONCLUSION: The TCNS is a valid and reliable scale for a wide spectrum of polyneuropathies, and might be useful in clinical practise and research for the diagnosis and staging of polyneuropathy.

Phenobarbital administration every eight hours: improvement of seizure management in idiopathic epileptic dogs with decreased phenobarbital elimination half-life.

Estimated prevalence of canine idiopathic epilepsy is 0.6 per cent in the first-opinion canine population in the UK. Phenobarbital monotherapy has been reported to reduce/eradicate seizure activity in 60-93 per cent of idiopathic epileptic dogs (IEDs). The objective of this study was to evaluate safety and efficacy of the administration of phenobarbital orally every eight hours in IEDs with phenobarbital elimination half-life less than 20 hours. Medical records of 10 IEDs in which steady state trough serum phenobarbital levels were within the reference range and phenobarbital elimination half-life had become less than 20 hours following prolonged administration every 12 hours were reviewed. Side effects and seizure frequency when phenobarbital was administered every 12 hours or 8 hours were compared. In all dogs the side effects of the antiepileptic medication treatment improved. When phenobarbital was administered every eight hours, 9/10 dogs experienced improvement in seizure frequency and 8/10 dogs maintained seizure freedom for a period three times longer than the longest interictal interval period previously recorded. Reduction in the severity and number of clusters of seizures was recorded in one of the remaining two dogs. The administration of phenobarbital orally every eight hours in IEDs with decreased phenobarbital elimination half-life appears safe and can improve seizure management. The results of this study were presented in abstract form (poster) for the 28th symposium of the European Society of Veterinary Neurology - European College of Veterinary Neurology (ESVN), September 18-19, 2015, Amsterdam, Netherlands.

The road less travelled: Australian women's experiences with vulval cancer.

Despite advances in surgical treatments and the availability of more conservative treatment options, women treated for vulval cancer still experience significant complications such as urinary incontinence, lymphoedema, pruritus, sexual and intimacy issues. These issues can profoundly impact a woman's quality of life. The subjective experience of women diagnosed and treated for vulval cancer in the literature is limited, possibly due to its comparable rarity to other gynaecological and female cancers and because it was traditionally seen mainly in the elderly female population. Nonetheless, younger women are also being diagnosed with vulval cancer. This paper reports the findings from a qualitative study about twelve women's experiences with vulval cancer from diagnosis, through treatment and recovery. Women's feelings of isolation, their unmet information and support needs, physical concerns arising from vulval cancer, particularly after surgery, and the consequences for their body image and intimate relationships with partners, were highlighted within the data. The central findings from this study emphasise the need for further research to develop appropriate interventions for women with vulval cancer. It also highlights opportunities to improve clinical practice into the supportive care of women with this isolating disease.

Improving the quantity, quality and transparency of data used to derive radionuclide transfer parameters for animal products. 2. Cow milk.

Under the International Atomic Energy Agency (IAEA) MODARIA (Modelling and Data for Radiological Impact Assessments) Programme, there has been an initiative to improve the derivation, provenance and transparency of transfer parameter values for radionuclides from feed to animal products that are for human consumption. A description of the revised MODARIA 2016 cow milk dataset is described in this paper. As previously reported for the MODARIA goat milk dataset, quality control has led to the discounting of some references used in IAEA's Technical Report Series (TRS) report 472 (IAEA, 2010). The number of Concentration Ratio (CR) values has been considerably increased by (i) the inclusion of more literature from agricultural studies which particularly enhanced the stable isotope data of both CR and Fm and (ii) by estimating dry matter intake from assumed liveweight. In TRS 472, the data for cow milk were 714 transfer coefficient (Fm) values and 254 CR values describing 31 elements and 26 elements respectively. In the MODARIA 2016 cow milk dataset, Fm and CR values are now reported for 43 elements based upon 825 data values for Fm and 824 for CR. The MODARIA 2016 cow milk dataset Fm values are within an order of magnitude of those reported in TRS 472. Slightly bigger changes are seen in the CR values, but the increase in size of the dataset creates greater confidence in them. Data gaps that still remain are identified for elements with isotopes relevant to radiation protection.