Transcranial focused ultrasound for the treatment of tremor: A preliminary case series.

BACKGROUND: Essential tremor (ET) can be debilitating. Treatments for ET include beta-blockers and surgical interventions. Low-intensity focused ultrasound (LIFU) may offer an office-based non-invasive alternative. OBJECTIVE: This pilot open label clinical trial explores safety, feasibility, and potential efficacy of LIFU in treatment of ET. METHODS: We report outcomes from the first 10 participants in this IRB-approved trial of LIFU for treatment of ET. The ventral intermediate nucleus of the thalamus (Vim) was targeted using structural and functional MRI. Participants underwent eight 10-min sessions of LIFU targeting the contralateral (Vim) to the most affected hand. Safety was closely monitored; Global Rating of Change (GRC) and The Essential Tremor Rating Scale (TETRAS) scores were collected. RESULTS: No adverse effects were reported. Eight participants reported a GRC ≥2. TETRAS performance subscale demonstrated clinically significant improvement in all participants. CONCLUSION: Preliminary findings support LIFU's safety and feasibility. The potential efficacy encourages additional sham-controlled studies.

To which extent do breast cancer survivors feel well informed about disease and treatment 5 years after diagnosis?

OBJECTIVE: In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. METHODS: In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. RESULTS: There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (ß 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (ß - 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (ß -0.34, p 0.03) and by immigrants (ß -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (ß 0.19/0.19/0.20/0.25; each p < 0.01). CONCLUSION: Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.

A life cycle assessment of liquid pig manure transport in line with EU regulations: A case study from Germany.

The transport of excess manure to crop farming systems is a core measure of livestock farmers to comply with environmental regulations like the EU Nitrates Directive. The German implementation of the directive has recently been revised and will lead to a distinct increase of manure transport. We quantify the environmental impact of 1 m3 of pig manure excreted in scenarios with and without manure transport by life cycle assessment, focusing on farming systems in North-West Germany. Furthermore, we assess how the environmental impact is linked to the regulation which is causing the transport. Compared to a reference scenario without transport, manure transport lowers all assessed impact categories and no trade-off between environmental impacts is found. Major reductions are realized for global warming (39%), freshwater (61%) and marine eutrophication (54%) as well as particulate matter formation (10%). Furthermore, the depletion of fossil fuels and phosphate is lowered. Reductions are mainly caused by an increase of nutrient use efficiency and the savings in chemical fertilizer. However, in a scenario where manure transport is caused by strict regulations regarding phosphate, needed nitrogen leaves the exporting farm likewise and chemical fertilizer use rises at the exporting farm. Caused by the increased fertilizer use, the positive environmental effect of manure transport diminishes, even leading to a rise of fossil fuel depletion by 20% and slight rise of global warming potential by 3%. However, we find that the use of lorries which combine manure and grain transport and, thereby, reduce empty drives, can prevent this trade-off. Our results show the potential of manure transport to reduce the environmental burden caused by the geographical concentration of livestock production. However, the impact of manure transport on global warming and fossil fuel depletion highly depends on the transport distance. Agronomic measures are needed to prevent the increase of chemical N fertilizer use on the exporting farms and policy makers should be aware of possible trade-offs between strict regulations regarding phosphorus and fossil fuel depletion.

[Cost-utility analysis of ranibizumab (Lucentis) in neovascular macular degeneration]. / Was darf Lebensqualität kosten?--Kosten-Nutzwertanalyse von Ranibizumab (Lucentis) bei altersabhängiger Makuladegeneration.

PURPOSE: Ranibizumab (Lucentis) stabilizes or improves visual acuity in a high percentage of patients with age-related macular degeneration (AMD). As this therapy is associated with significant costs, the aim of this study was to provide a cost-utility analysis, which considers both costs and utility of a therapy with ranibizumab in an economic model. METHODS: The incremental utility for the patient was modelled based on visual acuity data of the MARINA and ANCHOR study. The utility data used assume that the better seeing eye is affected. The study groups used for comparison consisted of patients who only received best supportive care, e. g., low-vision aids. The baseline scenario of the model assumes 6 treatments per year over a 2 year time period - based on the assessment of an expert panel. Treatment costs were based on German pharmacy prices and recommendations for reimbursement of the intravitreal injections. In a univariate sensitivity analysis all important parameters were varied to assess the stability of the results. RESULTS: The baseline scenario yields for predominantly classic lesions 16,882 euro/QALY (quality adjusted life year), for minimally classic CNV 24,766 euro/QALY and for occult CNV 26,170 euro/QALY. If a distribution of the CNV types with 18 - 25 - 57 % is assumed, the mean cost of therapy with ranibizumab amounts to 24,147 euro/QALY. Sensitivity analysis showed that all reasonable variations yielded results which are considered cost-effective ( 0.4) visual acuity, for a variation of costs per treatment of +/- 20 %, and a prolonged treatment duration of 3 years. CONCLUSIONS: In the investigated szenario a therapy of neovascular AMD with ranibizumab is cost-effective for all angiographic subtypes as well as in the sensitivity analysis.