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1.
Support Care Cancer ; 32(7): 432, 2024 Jun 14.
Article in English | MEDLINE | ID: mdl-38874678

ABSTRACT

PURPOSE: Upper gastrointestinal (GI) cancers contribute to 16.7% of UK cancer deaths. These patients make high use of acute hospital services, but detail about palliative care use is lacking. We aimed to determine the patterns of use of acute hospital and hospital specialist palliative care services in patients with advanced non-curative upper GI cancer. METHODS: We conducted a service evaluation of hospital use and palliative care for all patients with non-curative upper GI cancer seen in one large hospital, using routinely collected data (2019-2022). We report and characterise hospital admissions and palliative care within the study time period, using descriptive statistics, and multivariable Poisson regression to estimate the unadjusted and adjusted incidence rate ratio of hospital admissions. RESULTS: The total with non-curative upper GI cancer was 960. 86.7% had at least one hospital admission, with 1239 admissions in total. Patients had a higher risk of admission to hospital if: aged ≤ 65 (IRR for 66-75 years 0.71, IRR 76-85 years 0.68; IRR > 85 years 0.53; p < 0.05), or lived in an area of lower socioeconomic status (IMD Deciles 1-5) (IRR 0.90; p < 0.05). Over the 4-year period, the rate of re-admission was higher in patients not referred to palliative care (rate 0.52 readmissions/patient versus rate 1.47 readmissions/patient). CONCLUSION: People with advanced non-curative gastrointestinal cancer have frequent hospital admissions, especially if younger or from areas of lower socioeconomic status. There is clear association between specialist palliative care referral and reduced risk of hospitalisation. This evidence supports referral to specialist palliative care.


Subject(s)
Gastrointestinal Neoplasms , Hospitalization , Palliative Care , Humans , Palliative Care/statistics & numerical data , Palliative Care/methods , Aged , Male , Female , Aged, 80 and over , Gastrointestinal Neoplasms/therapy , Middle Aged , Hospitalization/statistics & numerical data , United Kingdom , Adult
2.
Clin Radiol ; 79(4): e624-e633, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38320944

ABSTRACT

AIM: To compare the effectiveness and safety of pharmacological thrombolysis and mechanical thrombectomy. MATERIAL AND METHODS: This review was conducted in accordance with the PRISMA guidelines. Pooled proportions and subgroup analysis were calculated for primary and secondary patency rates, technical success, clinical success, major and minor complications rates. RESULTS: This systematic review identified a total of 6,492 studies of which 17 studies were included for analysis. A total of 1,089 patients comprising 451 (41.4 %) and 638 (58.6 %) patients who underwent thrombolysis and mechanical thrombectomy procedures, respectively, were analysed. No significant differences were observed between thrombolysis and mechanical thrombectomy procedures in terms of technical success, clinical success, major and minor complications rates, primary and secondary patency rates; however, subgroup analysis of overall arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) demonstrated a significantly higher rate of major complications within the AVF group (p=0.0248). CONCLUSION: The present meta-analysis suggests that pharmacological thrombolysis and mechanical thrombectomy procedures are similarly effective and safe; however, AVFs are subject to higher major complications compared to AVGs.


Subject(s)
Arteriovenous Shunt, Surgical , Graft Occlusion, Vascular , Thrombectomy , Thrombolytic Therapy , Humans , Thrombolytic Therapy/methods , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/methods , Thrombectomy/methods , Graft Occlusion, Vascular/diagnostic imaging , Thrombosis , Vascular Patency , Treatment Outcome , Fibrinolytic Agents/therapeutic use
3.
Med J Malaysia ; 79(2): 165-169, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38553921

ABSTRACT

INTRODUCTION: Chronic refractory breathlessness is a debilitating symptom which negatively affects quality of life with profound impact on physical and psychosocial functioning of patients and/or carers. Multidisciplinary based interventions which focus on non-pharmacological approach have shown to be effective. We developed a breathlessness intervention service called breathlessness supportive therapy (BST) in a palliative care unit with limited resources. The aim is to evaluate the feasibility of developing a BST service and to study the characteristics and outcome of patients with chronic refractory breathlessness. MATERIALS AND METHODS: This is a retrospective study of patients with chronic refractory breathlessness and Modified Medical Research Council (mMRC) dyspnoea scale grade ≥ 2 who attended the BST clinic over 1 year period. BST consists of two clinic sessions 2 weeks apart. Data was retrieved from patients' medical notes and analysis done using Microsoft Excel. RESULTS: A total of 21 patients were identified. Median age was 69 years with 52% of females. 72% had non-malignant diagnoses. Median Charlson's Comorbidity Index score was 6.5. Median mMRC dyspnoea scale was 3. 47.6% had long term oxygen usage. Median Australian Karnofsky Performance Scale (AKPS) was 65 and the median baseline breathlessness visual analogue scale (VAS) was 2. 62% completed two sessions, the remaining 38% completed only one session. Mean time from BST intervention to death was 18.26 weeks, median was 22 weeks. 72% died at home, whilst 28% died in the hospital. All the patients scored 4 (somewhat agree) and 5 (strongly agree) on the overall feedback score. CONCLUSIONS: Development of a breathlessness intervention service is feasible in a resource limited setting and generally accepted by most patients. More research and prospective studies are needed to evaluate the effectiveness of BST in the future.


Subject(s)
Palliative Care , Quality of Life , Female , Humans , Aged , Retrospective Studies , Australia , Dyspnea/etiology , Dyspnea/therapy , Dyspnea/diagnosis
4.
Clin Radiol ; 77(9): 678-683, 2022 09.
Article in English | MEDLINE | ID: mdl-35717409

ABSTRACT

AIM: To examine the relationship between catheter tip location and catheter dysfunction in the context of tunnelled central venous catheters (CVCs) for haemodialysis. MATERIALS AND METHODS: This was a retrospective study of 993 haemodialysis patients who underwent insertion of tunnelled CVCs of step-tip design via the right internal jugular vein (IJV). Based on intra-procedural radiographs, the catheter tip was characterised as being in the superior vena cava (SVC), cavo-atrial junction (CAJ), or deep right atrium (DRA). Patients were tracked for 90 days post-procedure for complications resulting in catheter replacement, and these were compared between cohorts. Statistical analysis was performed with Pearson's chi-square and Fisher's exact tests for categorical variables and two-sample t-test and one-way analysis of variance (ANOVA) for continuous variables. RESULTS: Ninety-five patients (9.6%) experienced catheter dysfunction necessitating replacement within 90 days of insertion. Tip location in SVC was associated with lower occurrence of catheter dysfunction (1.9%) as compared with the CAJ (8%) and DRA (11%; p=0.049). Catheter replacement due to other complications (catheter-associated bacteraemia, cuff dislodgement, exit-site infection, external catheter damage) showed no statistically significant relation to location of the CVC tip. CONCLUSION: When utilising tunnelled CVCs with a step-tip design inserted via the right IJV, location of the catheter tip in the SVC is associated with reduced occurrence of catheter dysfunction as compared to either the CAJ or DRA.


Subject(s)
Catheterization, Central Venous , Central Venous Catheters , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Humans , Jugular Veins/diagnostic imaging , Renal Dialysis , Retrospective Studies , Vena Cava, Superior/diagnostic imaging
5.
Appl Opt ; 61(1): 308-315, 2022 Jan 01.
Article in English | MEDLINE | ID: mdl-35200833

ABSTRACT

Fiber optical parametric amplifiers (FOPAs) operating based on four-wave mixing (FWM) are versatile devices with increasing applications in optical communication systems. In this paper, the effects of dispersion fluctuations on the performance of bandwidth, ripple, parametric gain, and saturation power of a two-pump FOPA based on four-wave and six-wave models are studied and compared. Coupled-amplitude equations representing the non-degenerate FWM process in optical fiber are solved numerically to compute the parametric gain over the communication wavelengths. The behaviors of the performance parameters are critically analyzed and compared with different types of fluctuation strengths (or amplitudes) specified by the combinations of correlation length (Lc) and fluctuation amplitude (σ). Based on the results, it was found that the flat gain bandwidth for the four-wave model remains unchanged and is insensitive to the strengths of fluctuations. The gain ripples, however, get higher as the fluctuation strengths increase. On the other hand, the flat gain bandwidths of the six-wave model are hardly identified due to the tremendous and continuous ripples within the pump wavelengths. In addition, the minimum parametric gain values for both four-wave and six-wave models reduce as the fluctuation strengths increase. Also, the lowest value of parametric gain leads to the highest saturation power and vice versa. The dispersion fluctuations affect the FWM process's efficiency and deteriorate the overall amplifier performance, particularly for the six-wave model. The numerical analysis obtained via the six-wave model is especially useful since this model closely matches with practical circumstances.

6.
Osteoporos Int ; 32(11): 2217-2224, 2021 Nov.
Article in English | MEDLINE | ID: mdl-33959793

ABSTRACT

Hip fractures are common in the elderly, and many patients with hip fractures have low vitamin D levels. This study found that severe vitamin D deficiency is linked to poorer recovery of function and quality of life after hip fracture surgery. INTRODUCTION: Vitamin D deficiency is prevalent in hip fracture patients and associated with increased mortality and complications. However, there is limited long-term data on how vitamin D levels affect functional outcomes after hip fracture surgery. The aim of this study is to ascertain the association between vitamin D levels and recovery from hip surgery. METHODS: Patients who underwent hip fracture surgery from January 2012 to December 2016 and had vitamin D levels assessed during admission were included. Retrospective analysis was performed on patients' demographic data such as age, gender and clinical parameters such as preoperative vitamin D, haemoglobin levels, Charlson Comorbidity Index (CCI), and type and site of surgery. Patients were divided according to four different vitamin D levels-severe vitamin D deficiency (≤10 ng/mL), mild deficiency (10-20 ng/ml), insufficiency (20-30 ng/ml), and normal (>30ng/ml). Functional outcomes were measured by Harris Hip Score (HHS), Parker Mobility Score (PMS), and individual domains of 36-Item Short Form Health Survey (SF36). Univariate and multivariate analyses were conducted to examine the association between vitamin D deficiency and functional outcome scores. RESULTS: Out of 664 patients identified, 9% had severe vitamin D deficiency and 39% mild deficiency. Patients with severe vitamin D deficiency had significantly poorer baseline and 6-month PMS and SF36 Physical Functioning (PF). In multivariate analysis, severe vitamin D deficiency was associated with lower 6-month PMS and SF36 PF. CONCLUSION: Preoperative severe vitamin D deficiency is an independent risk factor for poorer recovery of function and quality of life after hip fracture surgery.


Subject(s)
Hip Fractures , Vitamin D Deficiency , Aged , Hip Fractures/epidemiology , Hip Fractures/etiology , Hip Fractures/surgery , Humans , Quality of Life , Retrospective Studies , Risk Factors , Vitamin D , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology
7.
Clin Radiol ; 76(2): 157.e1-157.e10, 2021 Feb.
Article in English | MEDLINE | ID: mdl-32993879

ABSTRACT

AIM: To evaluate the ultra-lose dose imaging protocol (ULDP), compared to the standard low-dose imaging protocol (LDP), which are used for haemodialysis access, in terms of radiation exposure and image quality. MATERIAL AND METHODS: This was a single-centre, institutional review board-approved, prospective, double-blinded randomised controlled study to compare radiation exposure and image quality of the ULDP and LDP. Ten proceduralists, two radiographers, and 11 nurses were enrolled. Radiation exposure during 80 procedures (40 angioplasties and 40 thrombolysis) was recorded (direct radiation to patients from protocol report and scattered radiation to participants from the RaySafe i2 real-time dosimetry system). Baseline characteristics of procedure were recorded. Image quality was assessed subjectively using questionnaires based on the five-point Likert scale after each procedure. RESULTS: Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses (0.506±0.430 versus 0.847±0.965 µSv/s, p=0.044; 0.571±1.284 versus 1.284±1.007 mGy/s, p<0.001; and 0.052±0.071 versus 0.141±0.185 µSv/s, p=0.005, respectively). No significant difference in image quality or duration of procedure was observed (all p values >0.05). CONCLUSION: Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses without compromising the image quality or duration of procedure.


Subject(s)
Angiography, Digital Subtraction/methods , Angioplasty/methods , Graft Occlusion, Vascular/surgery , Mechanical Thrombolysis/methods , Radiation Dosage , Radiation Exposure/statistics & numerical data , Adult , Clinical Protocols , Double-Blind Method , Female , Fluoroscopy , Humans , Male , Prospective Studies
8.
Med J Malaysia ; 76(2): 233-235, 2021 03.
Article in English | MEDLINE | ID: mdl-33742634

ABSTRACT

In recognising the palliative care (PC) needs globally and in Malaysia, services were developed to serve the rural area of Kuala Lipis, Pahang. This communication describes the initial a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, stages of development towards achieving a successful implementation. PC services were led by Kuala Lipis district hospital include inpatient referrals, outpatient and community care through home visits. These services involve multi-disciplinary team inclusive of representatives from health clinics and allied health. Referrals and opioid usage have demonstrated an increasing trend since its implementation in October 2018. Implementation of rural PC services is feasible; however, long-term sustainability needs to addressed.


Subject(s)
Hospitals, District , Palliative Care , Humans , Malaysia , Referral and Consultation , Rural Population
9.
Eur J Neurol ; 27(6): 959-966, 2020 06.
Article in English | MEDLINE | ID: mdl-32124496

ABSTRACT

BACKGROUND AND PURPOSE: This study quantified the total brain and periventricular white matter hyperintensity (WMH) burdens in patients with early Parkinson's disease (PD) and explored their associations with cardiovascular risk factors and cognitive performance. METHODS: A total of 175 non-demented patients with early PD who had undergone baseline brain magnetic resonance imaging were included. Comprehensive neurocognitive testing was conducted to identify PD with mild cognitive impairment (PD-MCI) and to evaluate performances in individual cognitive domains. Cardiovascular risk was expressed as a modified Framingham 10-year cardiovascular risk score (mFRS). RESULTS: A total of 53.7% of this early PD cohort fulfilled the diagnostic criteria for PD-MCI. An increase in mFRS was significantly associated with increases in the total brain WMH (P = 0.015) and periventricular WMH (P = 0.040) burden, independent of age and gender. The periventricular WMH burden was significantly associated with PD-MCI (P = 0.046) in early PD, independent of cardiovascular risk factors. Patients in the 5th quintile of periventricular WMH burden were 8.6 times more likely to have PD-MCI compared with patients in the 1st quintile of periventricular WMH burden (P = 0.004). However, total brain WMH burden was not associated with PD-MCI (P = 0.158). In individual cognitive domains, heavier periventricular WMH burden was associated with worse executive function and visuospatial function independent of cardiovascular risk factors. CONCLUSION: Periventricular WMHs are a useful imaging biomarker for cognitive impairment in early PD. Cardiovascular risk factors, although associated with periventricular WMHs, were unable to fully explain the association between periventricular WMHs and cognitive impairment in early PD.


Subject(s)
Cognitive Dysfunction , Parkinson Disease , White Matter , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Executive Function , Humans , Magnetic Resonance Imaging , Parkinson Disease/complications , Parkinson Disease/diagnostic imaging , Parkinson Disease/epidemiology , White Matter/diagnostic imaging
10.
Clin Radiol ; 75(6): 415-422, 2020 06.
Article in English | MEDLINE | ID: mdl-32291080

ABSTRACT

Coronavirus disease 2019 (COVID-19) has spread fast and extensively around the world, with significant mortality and morbidity. As this is a respiratory infection, chest radiography and computed tomography (CT) are important imaging techniques in the work-up of this disease. Given its highly infectious nature, cross-infection within the healthcare setting and radiology departments needs to be addressed actively and prevented. We describe the response of radiology departments in Singapore to this pandemic, in terms of diagnosis, re-configuration of the department, re-organisation and segregation of staff, infection control, managerial, and leadership issues.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , COVID-19 , Coronavirus Infections/epidemiology , Health Resources , Humans , Organization and Administration , Pandemics , Pneumonia, Viral/epidemiology , Radiography, Thoracic , Radiology Department, Hospital , Singapore/epidemiology , Tomography, X-Ray Computed
11.
Med Vet Entomol ; 34(4): 379-384, 2020 12.
Article in English | MEDLINE | ID: mdl-32232987

ABSTRACT

In the past decade, new strategies have been developed to control the Aedes aegypti (Diptera: Culicidae) mosquito vector, as well as a broad range of arboviral agents. Vector control surveillance programmes in Puerto Rico and Australia have implemented the Centers for Disease Control and Prevention autocidal gravid ovitrap (AGO), which has had an impact on vector density and, consequently, the epidemiology of arboviral infections. Colombia intends to establish the AGO as a new tool for the surveillance and control of the A. aegypti vector. AGOs were evaluated in a hyperendemic area for dengue virus during an 8-week period in Villavicencio city, eastern Colombia. The results indicated that the AGOs detect a high density of A. aegypti, with positive results for these traps of over 80% and an average catch of six individuals per trap per week. Acceptance of AGOs in the community exceeded 95%, and adherence was around 89%. This study's results demonstrate, for the first time in Colombia, that traps are a useful tool for the surveillance of A. aegypti. Future studies must consider the implementation of AGOs in the region.


Subject(s)
Aedes , Mosquito Control/methods , Aedes/virology , Animals , Colombia/epidemiology , Dengue/transmission , Dengue Virus , Mosquito Vectors/virology
12.
Eur J Neurol ; 26(3): 400-406, 2019 03.
Article in English | MEDLINE | ID: mdl-30175887

ABSTRACT

BACKGROUND AND PURPOSE: The aim of this study was to examine non-motor symptoms in different Parkinson's disease (PD) motor subtypes and their associations with quality of life (QoL). METHODS: A total of 132 patients with early PD with comprehensive motor examinations and non-motor symptom assessments were included. Motor subtypes were classified based on Stebbins' method. Non-motor symptoms were assessed by the Non-Motor Symptom Scale (NMSS) and validated by more comprehensive instruments, including the Pittsburgh Sleep Quality Index (PSQI) and Fatigue Severity Scale (FSS). QoL was measured by the Parkinson's Disease Questionnaire-8. RESULTS: We identified 66 patients (50%) with tremor-dominant (TD) subtype, 47 (35.6%) with postural instability and gait disorder (PIGD) subtype and 19 (14.4%) with Intermediate subtype. By comparing NMSS scores, patients with the PIGD subtype had more severe sleep impairment and fatigue (domain 2 score: 5.64 vs. 2.52, P < 0.001), urinary symptoms (domain 7 score: 6.96 vs. 3.48, P = 0.005) and overall more severe non-motor symptoms (NMSS total score: 25.89 vs. 17.27, P = 0.031), compared with patients with the TD subtype. Validation using the PSQI and FSS again suggested that patients with the PIGD subtype had independently and significantly more severe sleep impairment (PSQI score: 5.57 vs. 4.29, P = 0.020) and fatigue (FSS score: 34.81 vs. 25.85, P = 0.003) compared with patients with the TD subtype. Several non-motor symptoms had significant associations with QoL, among which sleep impairment and fatigue (P < 0.0001, partial r2 = 0.273) explained the largest proportion of QoL variability in patients with PD. CONCLUSIONS: Patients with the PIGD subtype had more severe sleep impairment, fatigue and urinary disturbance compared with patients with the TD subtype. Sleep impairment and fatigue were the most important factors affecting QoL independent of motor subtypes. Prompt identification and treatment of these non-motor symptoms may improve patients' QoL.


Subject(s)
Fatigue , Parkinson Disease , Quality of Life , Sleep Wake Disorders , Aged , Fatigue/etiology , Fatigue/physiopathology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Parkinson Disease/classification , Parkinson Disease/complications , Parkinson Disease/physiopathology , Sleep Wake Disorders/etiology , Sleep Wake Disorders/physiopathology
13.
J Women Aging ; 30(6): 503-519, 2018.
Article in English | MEDLINE | ID: mdl-28777712

ABSTRACT

The different pathways out of the labor force have been the focus of many recent studies, yet not enough scholarly attention has been paid to the effect of country-level, individual, and job characteristics and their potentially different influence across genders. The current article examines the relationships between retirement decisions and macroeconomic conditions, personal characteristics, and job satisfaction, while focusing on gender differences. Data came from 16,337 respondents in 13 European countries that participated in the Survey of Health, Ageing and Retirement in Europe (SHARE). We find that the relative importance of macroeconomic conditions and job satisfaction differs by gender.


Subject(s)
Employment/statistics & numerical data , Health Behavior , Health Status , Job Satisfaction , Retirement/statistics & numerical data , Age Factors , Europe , Female , Humans , Male
14.
Clin Exp Immunol ; 189(3): 298-303, 2017 09.
Article in English | MEDLINE | ID: mdl-28388832

ABSTRACT

To measure the levels of B cell-activating factor (BAFF) and endogenous anti-BAFF autoantibodies in a cohort of multi-ethnic Asian systemic lupus erythematosus (SLE) patients in Singapore, to determine their correlation with disease activity. Serum samples from 121 SLE patients and 24 age- and sex-matched healthy controls were assayed for BAFF and anti-BAFF immunoglobulin (Ig)G antibody levels by enzyme-linked immunosorbent assay (ELISA). The lowest reliable detection limit for anti-BAFF-IgG antibody levels was defined as 2 standard deviations (s.d.) from blank. Correlation of serum BAFF and anti-BAFF IgG levels with disease activity [scored by SLE Activity Measure revised (SLAM-R)], and disease manifestations were determined in these 121 patients. SLE patients had elevated BAFF levels compared to controls; mean 820 ± 40 pg/ml and 152 pg ± 45/ml, respectively [mean ± standard error of the mean (s.e.m.), P < 0·01], which were correlated positively with anti-dsDNA antibody levels (r = 0·253, P < 0·03), and SLAM-R scores (r = 0·627, P < 0·01). In addition, SLE patients had significantly higher levels of anti-BAFF IgG, which were correlated negatively with disease activity (r = -0·436, P < 0·01), levels of anti-dsDNA antibody (r = -0·347, P < 0·02) and BAFF (r = -0·459, P < 0·01). The majority of patients in this multi-ethnic Asian SLE cohort had elevated levels of BAFF and anti-BAFF antibodies. Anti-BAFF autoantibody levels correlated negatively with clinical disease activity, anti-dsDNA and BAFF levels, suggesting that they may be disease-modifying. Our results provide further information about the complexity of BAFF pathophysiology in different SLE disease populations and phenotypes, and suggest that studies of the influence of anti-cytokine antibodies in different SLE populations will be required when selecting patients for trials using targeted anti-cytokine therapies.


Subject(s)
Autoantibodies/blood , B-Cell Activating Factor/blood , B-Cell Activating Factor/immunology , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/physiopathology , Adult , Asian People , Autoantibodies/immunology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Limit of Detection , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/ethnology , Male , Middle Aged , Singapore/epidemiology
15.
World J Urol ; 35(5): 695-701, 2017 May.
Article in English | MEDLINE | ID: mdl-27637908

ABSTRACT

PURPOSE: To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT). METHODS: An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results. RESULTS: mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers. CONCLUSIONS: The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community.


Subject(s)
Magnetic Resonance Imaging , Prostatic Neoplasms/diagnostic imaging , Ablation Techniques , Biopsy , Cryosurgery , Delphi Technique , Electrochemotherapy , High-Intensity Focused Ultrasound Ablation , Humans , Laser Therapy , Male , Pathologists , Photochemotherapy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Radiologists , Surveys and Questionnaires , Urologists
16.
Appl Opt ; 56(29): 8303-8308, 2017 Oct 10.
Article in English | MEDLINE | ID: mdl-29047698

ABSTRACT

The impact of random dispersion fluctuations on the gain and saturation behavior of a one-pump fiber optical parametric amplifier (1-P FOPA) in the presence of fourth-order dispersion coefficient (ß4) is investigated. Three coupled amplitude equations with fiber losses are solved numerically for the calculation of the pump, signal, and idler. The performances of 1-P FOPA are also analyzed with variation of dispersion fluctuation amplitude (σ) and correlation length (Lc). Based on the numerical results, it is found that the gain spectra and saturation curves exhibit some differences when ß4 is considered. In comparison with the case where ß4 is ignored, the peak gain remains the same, but the 3 dB bandwidth increases when ß4 exists. Another notable difference is that the saturation power is shifted to lower or higher values, depending on the σ and Lc parameters. In general, the peak gain reduces as σ increases, and the peak gain reduction is greater for the case of shorter Lc. The numerical analysis is probably useful, especially for the case where the signal wavelength is detuned far from the pump wavelength.

17.
World J Urol ; 34(10): 1373-82, 2016 Oct.
Article in English | MEDLINE | ID: mdl-26892160

ABSTRACT

PURPOSE: To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS: A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS: Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION: Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.


Subject(s)
Consensus , Delphi Technique , Prostatic Neoplasms/therapy , Quality of Life , Combined Modality Therapy/standards , Humans , Male , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Surveys and Questionnaires
19.
Int J Aging Hum Dev ; 83(2): 156-83, 2016 07.
Article in English | MEDLINE | ID: mdl-27199491

ABSTRACT

Two key theoretical frameworks that explain why people might hold biases for or against a specific age group-cultural stereotypes and in-group favoritism-yield distinct and sometimes contradictory predictions. This study proposes a combined framework drawing on these two theories and then tests hypotheses based on this framework in the workplace context. Using survey data from U.S. employees of two pharmaceutical companies, we evaluated the extent to which respondents attributed characteristics related to innovation or change and reliable performance to other workers based on perceived relative age (the age of the target relative to the age of the respondent). The hypotheses that our combined framework generated were supported, but the results varied by type of characteristic as well as by age of the respondent. We conclude that the combined framework is more predictive of age bias in the workplace than either individual framework alone.


Subject(s)
Ageism/psychology , Employment/psychology , Group Processes , Psychological Theory , Social Perception , Adult , Female , Humans , Male , Middle Aged
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