Living with metastatic breast cancer (LIMBER): experiences, quality of life, gaps in information, care and support of patients in the UK.

PURPOSE: To determine the experiences, information, support needs and quality of life of women in the UK living with metastatic breast cancer (MBC) to provide content for educational materials. METHODS: An online survey, hosted for 3 months on a UK MBC charity website, comprised sections covering issues such as communication about MBC treatment and management, helpful and less helpful things that healthcare professionals, family and friends did or said and completion of the Patient Roles and Responsibilities Scale (PRRS). RESULTS: A total of 143 patients participated; 48/143(33%) presented de novo; 54/143(38%) had been living with MBC > 2 years. PRRS analysis revealed that MBC imposed a serious impact upon most respondents' own caring abilities and social lives. A majority 98/139 (71%) wished they had known more about MBC before their diagnosis; 63/134(47%) indicated that they still did not fully understand their illness; merely 78/139(56%) had access to a specialist nurse and only 69/135(51%) had been offered any additional support. Respondents reported little consideration given to their lifestyle/culture during consultations and inconsistent information, support services, continuity of care or access to clinical trials. They commented upon things health care professionals/friends and family did or said that were useful and cited other behaviours that were especially unhelpful. CONCLUSIONS: MBC exerted a deleterious impact upon patients' activities of daily living which were exacerbated in part by significant gaps in support, communication and information. IMPLICATIONS FOR CANCER SURVIVORS: LIMBER results are informing the content of educational materials currently being developed for patients' formal and informal carers.

[Defusing of victims of the terrorist attacks in Paris. Elements of assessment one-month post-event]. / Defusing des victimes des attentats de Paris. Éléments d'évaluation un mois après.

The terrorist attacks (fusillades and suicide attacks) in Paris on 13 November 2015 have had a major psychic impact on all individuals directly or secondarily exposed to them. Medico-psychological unit (CUMP) of the Paris Île-de-France region's immediate care services were immediately mobilized and rapidly strengthened by all regional medico-psychological units (CUMP) throughout the country. Psychological assistance has been provided in several key points of Paris and specifically in the 11th district City Hall of Paris where Lyon's Medico-psychological unit was located. These specific immediate psychological assistances, referred to as a "defusing process" by the medico-psychological unit (CUMP), are mostly devoted to provide the victims with an entry point to a psychological healthcare relationship and give them a first sense of soothing and relief even though they do not prevent further psychological care follow up for the victims. Nonetheless, the potential therapeutic effect of this "defusing process" has not yet been sufficiently established nor demonstrated by any scientific study. A phoning survey was carried out one-month post-terrorist attacks and interviewed the 129 victims who benefited from the "defusing process" conducted by Lyon's medico-psychological unit (CUMP) in order to collect data and assess its effects. These people, whether directly exposed, bereaved relatives or witnesses, whose average age is 35, are mostly living in the Île-de-France region. Most of them present a high score on the IES-R scale, whether they were directly exposed, bereaved relatives or witnesses. Almost all of them (96.5%) experienced at least one medical care contact within this one-month post-trauma period with psychotropic medication for 37% of them. Regarding the defusing conducted by Lyon's medico-psychological unit (CUMP) in the 11th district City Hall of Paris, it appears that 93% of the victims who were looked after indicated that they were satisfied and 87.4% of them stated that they were soothed afterwards.

Effect of different concentrations of ginger root powder and its essential oil on growth performance, serum metabolites and antioxidant status in broiler chicks under heat stress.

1. This study was carried out to evaluate the impact of ginger (Zingiber officinale) feed supplementation on growth performance, antioxidant status, carcass characteristics and blood parameters in broiler chicks under conditions of heat stress (32 ± 2ºC for 8 h per d). 2. A total of 336 d-old male broiler chicks (Cobb-500) were randomly assigned to one of 6 dietary groups representing: basal diet with no supplement as control, basal diet containing 100 mg/kg vitamin E as positive control, basal diets containing either 7.5 or 15 g/kg of ginger root powder, and diets containing 75 or 150 mg/kg of ginger essential oil. 3. The results indicated that at 22 d of age, the group receiving 7.5 g/kg of ginger root powder experienced significantly increased body weight (BW) and body weight gain (BWG) compared to the control group. There were no significant difference among the diet groups regarding BW, BWG, feed intake (FI) or feed conversion ratio (FCR) at 42 and 49 d of age. 4. The inclusion of powder and essential oil of ginger in broiler diets did not affect carcass characteristics and blood parameters of the chickens. However, in the group receiving 150 mg/kg ginger essential oil, the total superoxide dismutase (TSOD) activity in liver increased compared to the control group. Malondialdehyde (MDA) concentrations in liver also decreased in the groups receiving ginger powder and essential oil compared to that in the control group. There were no significant difference between experimental groups regarding glutathione peroxidise (Gpx), TSOD and catalase (CAT) enzymes in red blood cells. All dietary groups increased total antioxidant capacity (TAC) and decreased MDA concentration in serum compared to the control group. 5. The results of this study suggest that ginger powder and essential oils may be a suitable replacement for synthetic antioxidants in broiler diets. Results also suggest that ginger powder might be better than extracted essential oil for improving antioxidant status in broilers.

Awareness and Observance Rate of the Patients' Rights Charter in General Hospitals; The Perspectives of Iranian Patients.

One of the most important indicators for assessing the quality of healthcare is the evaluation of patients' rights status and the interaction between patients and the healthcare providers. The patient rights charter improves communication between patients and service providers and enhances the quality of healthcare. This is a descriptive-analytic study that was performed on 500 patients referred to 25 general hospitals supervised by Tehran University of Medical Sciences. In this study, the observance rate of the patient rights charter was considered and the patient rights charter in the samples were studied based on dependency type of hospitals. The patients' opinions showed that the observance rate of the patient rights charter in the hospitals was 60.7%. Observance rate of patients' rights charter according to the dependency type of hospitals (governmental - private - public - charity) in all clauses of the patient rights charter was statistically significant (p = 0.000). The findings of this study indicate that the majority of clauses in the patients' rights charter is observed in hospitals. In the field of observing of the patient rights charter, increasing patient's awareness about their rights is a priority. And in the next step, comprehensive and assured laws are needed to observe patients' rights in healthcare centers.

Programmable CSF shunt valve: in vitro assessment of MR imaging safety at 3T.

A programmable CSF shunt valve was assessed for magnetic field interactions, heating (transmit-receive body radio-frequency coil; whole-body averaged specific absorption rate, 2.1 W/kg), functional alterations, and artifacts at 3T. The programmable valve showed minor magnetic field interactions and heating was not excessive (+0.8 degrees C). The function of the programmable valve was not altered by multiple exposures to the 3T scanner or from exposure to various MR imaging conditions. Therefore, this implant is safe for a patient undergoing MR imaging at 3T or less when the radiologist follows specific safety guidelines. Artifacts for the programmable valve were relatively large in relation to the size and shape of the valve; this finding may impact the diagnostic use of MR imaging if the area of interest is in proximity to this implant.

T cell subpopulations defined by monoclonal antibodies in autoimmune hemolytic anemia.

T cell subsets were studied using monoclonal anti-T cell antibodies in 10 patients with IgM cold agglutinins and 30 patients with IgG warm autoantibodies. Two of the 10 patients with cold agglutinin disease had abnormally low helper/suppressor T cell ratio. In the 30 patients with IgG warm autoantibodies this ratio was abnormally low in 7 and abnormally high in 7 other patients. Treatment by steroids or immunosuppressive agents tended to decrease OKT4/OKT8 ratio since high ratios were essentially found in untreated patients. This report documents the high incidence of T cell imbalance in autoimmune hemolytic anemia due to IgG warm autoantibodies and comments on its significance in the light of the great heterogeneity of this syndrome.

High-resolution 3T MR angiography of the carotid arteries: comparison of manual and semiautomated quantification of stenosis.

BACKGROUND AND PURPOSE: High-resolution contrast-enhanced MR angiography (CE-MRA) acquired at 3T exquisitely depict carotid artery (CA) stenosis. In this study, we examined the agreement of different vessel-analysis tools with manual quantitative measurement by 2 readers using CE-MRA data. MATERIALS AND METHODS: Three vessel tools determining the trajectory of the vessel of interest and, subsequently, the vessel dimensions were tested against manual measurements. Diameter and area stenoses were calculated. CE-MRA data of 32 patients with CA stenosis were evaluated. The agreement between different measurements was assessed with kappa statistics after categorizing stenosis (<25%, 25%-49%, 50%-69%, 70%-99%, and 100%). RESULTS: The mean grades of stenosis based on diameter measurements were 59% (readers) and 60%/56%/59% based on the analysis with tools A/B/C (P = 0.2-0.7). kappa values for agreement between readers and the vessel tools were 0.73/0.77/0.77 (tools A/B/C for all CAs) and 0.66/0.74/0.75 (for the symptomatic side). The mean grades of stenoses based on area measurements for tools A/B/C were 68%/63%/69% versus 58% for readers. Values from readers differed significantly from those for tools A and C (P < 0.01). kappa values for agreement between readers and the vessel tools were 0.66/0.55/0.64 (for all CAs) and 0.53/0.44/0.57 (for the symptomatic side). CONCLUSIONS: The automated approach allows accurate assessment of vessel dimensions in MRA images at least for diameter measurements according to the North American Symptomatic Carotid Endarterectomy Trial criteria.

Epidemiological study of gastro-oesophageal reflux disease: reflux in spouse as a risk factor.

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is a growing health-care problem with variable distribution. AIM: To assess GERD prevalence and risk factors and their possible correlation with pathophysiology in a population-based study. METHODS: Individuals aged 18-65 years were enrolled through random cluster sampling in Tehran. Previously validated self-administered questionnaires were used. RESULTS: Of the 2500 questionnaires, 2057 were analysed (mean age: 34.8 +/- 13.0 years, 55.1% female). Frequent GERD was seen in 18.2%. Minor symptoms increased prevalence. Female gender (OR: 1.55, 95% CI: 1.01-2.41), BMI >30 kg/m(2) (OR: 1.79, 95% CI: 1.03-3.12), less education (OR: 1.52, 95% CI: 1.02-2.27), smoking (OR: 1.83, 95% CI: 1.12-2.99), NSAID use (OR: 4.23, 95% CI: 1.66-10.74) and GERD in spouse (OR: 1.82, 95% CI: 1.18-2.82) were associated with frequent GERD on multivariable analysis. GERD in first-degree relatives (OR: 1.73, 95% CI: 1.23-2.43) and asthma (OR: 4.09, 95% CI: 1.27-13.15) correlated with infrequent GERD. Minor symptoms correlated with GERD history in first-degree relatives, coffee consumption and NSAID use. Prevalence in the past 3 months was similar to that in the past 12 months (P < 0.05). CONCLUSIONS: Gastro-oesophageal reflux disease is common in Tehran. The association of 'infrequent symptoms' with GERD history in first-degree relatives and 'frequent symptoms' with GERD history in spouse may point to the presence of yet unknown precipitating environmental factors inducing GERD in a genetically susceptible host. Minor GERD symptoms seem to have independent contribution to GERD. Assessing GERD in the past 3 months predicts prevalence in the past year.

Mutation analysis of the DBC2 gene in sporadic and familial breast cancer.

The expression of the recently identified tumor suppressor gene, DBC2 (Deleted in Breast Cancer 2), is frequently extinguished in breast cancer cells or tissues. Mutation analysis of the essential promoter region, all exons and exon/intron boundaries of the DBC2 gene was performed in 100 sporadic breast cancer cases by PCR-SSCP, and DHPLC, followed by direct sequencing. An additional 17 breast cancer families, who were negative for the BRCA1/2 mutations, were analyzed by direct sequencing. Three novel mutations were observed in the promoter and 5'-untranslated region (UTR) of the gene; a germ-line G>A transition in the promoter at nt -238 from the transcription start site, and two tumor-specific mutations at nt -121C>T and nt +48G>A. No deleterious mutations were detected in the coding sequence of the gene in familial and sporadic breast cancer cases. The sequence variations found within the promoter and 5'-UTR region of the gene warrant expression analysis and screening more tumor samples at this region.

Lymphocyte transformation test in uveal pathology.

Comparative studies of skin tests and in vitro lymphocyte transformation tests were found to be fruitful with the following antigens: tuberculin and PPD, Streptococcus, vaccine and protein M of Streptococcus, candidin, herpes antigen, Brucella antigen, antigen from autologous saliva. Three types of response occur: (1) positive skin test with syndromic ocular reaction and positive LTT: the diagnosis of hypersensitivity is certain; (2) positive skin test without syndromic reaction but positive LTT in vitro; less sensitive than the in vivo test but enhancing the value of the latter; the diagnosis is presumptive, and (3) skin test positive or negative and LTT negative: indicates that the in vitro test is less sensitive than the in vivo one. Practical interest of this comparison stems from those cases in whom skin testings is contra-indicated because it is considered to be dangerous (macular choroiditis, Eales' disease). Specific desensitization treatment was carried out on most of the cases and seemed to be effective in several of them.