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OBJECTIVE: Photodynamic diagnosis after instillation of hexylaminolevulinate (Hexvix(®)) during transurethral resection of the bladder (TURB) helps in the detection of tumors and results in a reduction of recurrence. The medical and economic impact of fluorescence compared to conventional white light TURB needed to be analyzed in the French healthcare system. The aim of this study was to evaluate the medical and economic impact of the blue light TURB in the treatment of NMIBC. MATERIALS AND METHODS: A cost-utility model, based on data from the literature and expert opinions, combining a decision tree and a Markov model was used to simulate the initial management after a first TURB of all new patients diagnosed with symptoms consistent with NMIBC and outcomes at short and long terms. In this model, the initial TURB could be achieved either with fluorescence in addition to white light, or with white light only. The main criteria of the model was based on the quality adjusted life years (QALY). The economic evaluation focused on the direct costs. The test's results and costs were determined from diagnosis until death of patients. RESULTS: The use of photodynamic diagnosis during TURB resulted in an improvement in QALYs (0.075) and a reduction of 670 of the costs compared to the conventional treatment with white light. Thus, the blue light resection was defined as a strategy called "dominant" over the TURB in white light. CONCLUSION: In the context of the French health system, the model of the study showed that the blue light cystoscopy during TURB was associated with increased QALYs and reduced health spending. This kind of result is rare in oncology. This health economic analysis confirms the interest of hexylaminolevulinate acid in initial management of NMIBC, according to studies conducted in United Kingdom, Italy and Poland.
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Carcinoma de Células de Transição/economia , Carcinoma de Células de Transição/cirurgia , Cistectomia/economia , Cistoscopia/economia , Neoplasias da Bexiga Urinária/economia , Neoplasias da Bexiga Urinária/cirurgia , Administração Intravesical , Idoso , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/análogos & derivados , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/epidemiologia , Redução de Custos , Análise Custo-Benefício , Cistectomia/métodos , Cistoscopia/métodos , Feminino , Fluorescência , França/epidemiologia , Humanos , Luz , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Observacionais como Assunto , Fármacos Fotossensibilizantes/administração & dosagem , Valor Preditivo dos Testes , Prevalência , Qualidade de Vida , Sensibilidade e Especificidade , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/epidemiologiaRESUMO
In order to improve the efficiency of X-ray absorption data recording, a fast scan method, the Turboscan, has been developed on the DEIMOS beamline at Synchrotron SOLEIL, consisting of a software-synchronized continuous motion of the monochromator and undulator motors. This process suppresses the time loss when waiting for the motors to reach their target positions, as well as software dead-time, while preserving excellent beam characteristics.
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OBJECTIVE: This analysis used data from the large (n = 1208) European Schizophrenia Cohort to examine the association between subjective side-effects of antipsychotic medication and the Mental and Physical Composite Scores (MCS; PCS) of the SF-36 scale. METHOD: Relationships between the subjective evaluation of side-effects identified from the Subjective Side-Effects Scale and the adjusted mean score on the PCS and MCS were examined. Where appropriate, these associations of subjective side-effects were compared with those of the same side-effects measured objectively. RESULTS: In this study, subjective side-effects of antipsychotic medication were linked either to both the PCS and the MCS or, in a few instances, to neither. Subjective evaluations of sexual side-effects were associated only with the MCS, those of sialorrhoea only with the PCS. Objective ratings of extrapyramidal side-effects were related neither to PCS nor to MCS. CONCLUSION: These data suggest that side-effects, whether subjective or objective, may need to be considered individually in relation to their impact on quality of life.
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Antipsicóticos/efeitos adversos , Qualidade de Vida/psicologia , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adulto , Antipsicóticos/uso terapêutico , Doenças dos Gânglios da Base/induzido quimicamente , Doenças dos Gânglios da Base/tratamento farmacológico , Doenças dos Gânglios da Base/psicologia , Peso Corporal/efeitos dos fármacos , Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/uso terapêutico , Doença Crônica , Estudos de Coortes , Seguimentos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/diagnóstico , Comportamento Sexual/efeitos dos fármacos , Sialorreia/induzido quimicamente , Sialorreia/psicologia , Adulto JovemRESUMO
BACKGROUND: Photodynamic diagnosis using the optical imaging agent hexaminolevulinate (HAL, Hexvix®, Ipsen Pharma GmbH, Ettlingen, Germany) as an adjunct to white light cystoscopy (WLC) during the initial transurethral resection of bladder tumours (TURB) improves the detection rate of bladder cancer and leads to fewer recurrences. OBJECTIVES: A cost-effectiveness analysis was carried out in order to calculate the consequences for the German healthcare system. METHODS: We combined a short-term decision tree and a Markov model to evaluate outcomes over a long period of time. The alternatives investigated were HAL-assisted blue light cystoscopy (BLC) as adjunct to WLC (HALâ¯+ BLC/WLC) compared with WLC alone in patients undergoing TURB. RESULTS: HALâ¯+ BLC/WLC compared to WLC alone was associated with 0.07 incremental quality-adjusted life years (QALYs) and cost savings of 537⯠per patient. CONCLUSION: HALâ¯+ BLC/WLC compared with WLC alone resulted in both cost savings and improved patient outcome rendering it the "dominant" strategy.
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Cistoscopia , Neoplasias da Bexiga Urinária , Análise Custo-Benefício , Alemanha , Humanos , Recidiva Local de NeoplasiaRESUMO
Undulator based synchrotron light sources and Free Electron Lasers (FELs) are valuable modern probes of matter with high temporal and spatial resolution. Laser Plasma Accelerators (LPAs), delivering GeV electron beams in few centimeters, are good candidates for future compact light sources. However the barriers set by the large energy spread, divergence and shot-to-shot fluctuations require a specific transport line, to shape the electron beam phase space for achieving ultrashort undulator synchrotron radiation suitable for users and even for achieving FEL amplification. Proof-of-principle LPA based undulator emission, with strong electron focusing or transport, does not yet exhibit the full specific radiation properties. We report on the generation of undulator radiation with an LPA beam based manipulation in a dedicated transport line with versatile properties. After evidencing the specific spatio-spectral signature, we tune the resonant wavelength within 200-300 nm by modification of the electron beam energy and the undulator field. We achieve a wavelength stability of 2.6%. We demonstrate that we can control the spatio-spectral purity and spectral brightness by reducing the energy range inside the chicane. We have also observed the second harmonic emission of the undulator.
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With gigaelectron-volts per centimetre energy gains and femtosecond electron beams, laser wakefield acceleration (LWFA) is a promising candidate for applications, such as ultrafast electron diffraction, multistaged colliders and radiation sources (betatron, compton, undulator, free electron laser). However, for some of these applications, the beam performance, for example, energy spread, divergence and shot-to-shot fluctuations, need a drastic improvement. Here, we show that, using a dedicated transport line, we can mitigate these initial weaknesses. We demonstrate that we can manipulate the beam longitudinal and transverse phase-space of the presently available LWFA beams. Indeed, we separately correct orbit mis-steerings and minimise dispersion thanks to specially designed variable strength quadrupoles, and select the useful energy range passing through a slit in a magnetic chicane. Therefore, this matched electron beam leads to the successful observation of undulator synchrotron radiation after an 8 m transport path. These results pave the way to applications demanding in terms of beam quality.
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The original version of this Article contained an error in the last sentence of the first paragraph of the Introduction and incorrectly read 'A proper electron beam control is one of the main challenges towards the Graal of developing a compact alternative of X-ray free-electron lasers by coupling LWFA gigaelectron-volts per centimetre acceleration gradient with undulators in the amplification regime in equation 11, nx(n-ß) x ß: n the two times and beta the two times should be bold since they are vectorsin Eq. 12, ß should be bold as well.' The correct version is 'A proper electron beam control is one of the main challenges towards the Graal of developing a compact alternative of X-ray free-electron lasers by coupling LWFA gigaelectron-volts per centimetre acceleration gradient with undulators in the amplification regime.'This has been corrected in both the PDF and HTML versions of the Article.
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The DEIMOS (Dichroism Experimental Installation for Magneto-Optical Spectroscopy) beamline was part of the second phase of the beamline development at French Synchrotron SOLEIL (Source Optimisée de Lumière à Energie Intermédiaire du LURE) and opened to users in March 2011. It delivers polarized soft x-rays to perform x-ray absorption spectroscopy, x-ray magnetic circular dichroism, and x-ray linear dichroism in the energy range 350-2500 eV. The beamline has been optimized for stability and reproducibility in terms of photon flux and photon energy. The main end-station consists in a cryo-magnet with 2 split coils providing a 7 T magnetic field along the beam or 2 T perpendicular to the beam with a controllable temperature on the sample from 370 K down to 1.5 K.
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This is a simple immunoturbidimetric method for the rapid assessment of alpha 1-acid glycoprotein in serum with the "Flexigem" microcentrifugal analyzer. Results obtained for a pediatric population (n = 95) agree with those by radial immunodiffusion (x) and yield the regression equation: y = 1.4x + 0.017 (r = 0.98). Results are printed automatically after a procedure that takes only about 15 min. Within-run precision (CV) ranged from 2.2 to 2.5% for concentrations of 0.35 to 2.4 g/L. Day-to-day CV was 4.25% for an average concentration of 0.9 g/L.
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Nefelometria e Turbidimetria/métodos , Orosomucoide/análise , Animais , Centrifugação/métodos , Cabras/imunologia , Humanos , Soros Imunes/imunologia , Técnicas ImunológicasRESUMO
A planar/helical crossed overlapped undulator, called OPHELIE, is presented, composed of two identical ten-period (each 25 cm long) crossed undulators whose magnetic fields are produced by electromagnets. Such a design is quite simple, with only one mechanical translational motion, and versatile. After the presentation of the general concept of the crossed undulator and of its actual magnetic design, the expected performances in terms of flux and polarization capabilities are described. It appears that any state of polarization can be produced, at least on the first harmonic, with a large total polarization rate and a potentially high polarization switching frequency.