Resigning oneself to a life of wound-related odour - A thematic analysis of patient experiences.

AIMS: To determine how patients with chronic wounds describe wound odour, identify what strategies they use to manage it and how effective these are. MATERIALS AND METHODS: Using a qualitative descriptive approach, semi-structured interviews were conducted between July and August 2021 with seven patients living with an odorous chronic wound at home. Data were analysed using Braun and Clarke's thematic analysis framework. RESULTS: The results were organised into two main themes: 1) becoming resigned to living with wound-related odour 2) strategies used to manage wound-related odour. Participants were sad, embarrassed and felt isolated but became resigned to living with this odour and accepting of it as a consequence of having a wound. Frequent dressing changes, household cleaning along with the use of sprays were the most frequently used tactics to manage odour none of which were deemed to be very effective. CONCLUSION: This study highlights the problem of odour management in clinical practice and how individuals develop strategies to overcome odour. Sadly, patients were resigned to living with wound odour and were accepting of it as part of daily life. This highlights the importance for healthcare professionals to recognise, assess for and ensure a better understanding of how people experience wound odour, the impact it can have on them personally. Frequent dressing changes can help manage wound odour from the patient's perspective.

Systematic review of topical interventions for the management of odour in patients with chronic or malignant fungating wounds.

Chronic wounds adversely affect the quality of life of individuals and odour is a well-recognised associated factor. Odour can affect sleep, well-being, social interactions, diet and potentially wound healing. This systematic review aims to examine the effectiveness of topical interventions in the management of odour associated with chronic and malignant fungating wounds. A systematic review guided by PRISMA recommendations of randomised controlled trials where odour intensity/odour is the primary outcome was undertaken. Inclusion criteria were adults (18 years and over) with chronic venous, arterial, diabetic or pressure ulcers or with malignant fungating wounds where odour has been managed through topical application of pharmacological/non-pharmacological agents. Searches were conducted in CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, and Web of Science. Eligibility screening, risk of bias assessment and data extraction was completed by authors working independently. Searches retrieved 171 titles and abstracts (157 post de-duplication). Thirteen studies were retained for full text review of which five (n = 137 individuals) examining the following treatments remained: metronidazole (n = 4), silver (n = 1). Meta-analysis was not possible but individual studies suggest improved outcomes (i.e., reduced odour) using metronidazole. Treatment options to manage wound odour are limited and hampered by lack of clinical trials, small sample sizes, and absence of standardised outcomes and consistent measurement. Whereas metronidazole and silver may have a role in controlling wound odour, robust and well-designed interventions with rigorous procedures and standardised odour outcomes are necessary to evaluate their contribution.

[Health, performance and use of medication in professional Swiss meat rabbit production]. / Gesundheit, Leistung und Medikamenten­einsatz in der professionellen Schweizer Fleischkaninchenproduktion.

INTRODUCTION: Husbandry conditions for rabbits in Switzerland are at a high animal welfare level in international comparison. Wire mesh flooring is prohibited and group housing is mandatory up to the age of eight weeks. Despite these animal-friendly husbandry standards, animal losses seem to be a significant problem, although reliable data on professional Swiss meat rabbit production is lacking to date. A herd survey was carried out in 52 rabbit farms to address this situation. At the same time, each new litter and each fattening group was documented with a standardized form focusing on animal death and the use of medication by the farmer over a one year period. In the case of increased mortality or new health problems, dead rabbits were sent to the National Reference Center for Poultry and Rabbit Diseases (Zurich) for pathological examination including bacteriological and parasitological diagnostics. Data from 32 farms were evaluated. The average mortality of young animals (birth to weaning) was 14.9% (1.0-30.0%) and of fattening rabbits (weaning to slaughter) 17.3% (4.3-31.8%). Intestinal diseases, mainly dysentery, intestinal coccidiosis and mucoid enteropathies, were the primary cause of death (68.2%). Eimeria spp., Escherichia coli and Clostridium perfringens were identified as the most frequent pathogens. Respiratory diseases were found in 18.7% of the examined rabbits, with Pasteurella multocida identified as the most common pathogen. 60.0% of the farms used antibiotics during the study period and a third (34.7%) of all the fattening animals were medicated with at least one antibiotic. The present results confirm that despite high animal welfare standards infectious diseases and mortality rates represent a considerable problem in professional Swiss meat rabbit production. Risk factors of increased morbidity and mortality should be identified to improve rabbit health, to reduce the high mortality rate and the extensive use of antibiotics in professional Swiss meat rabbit production. Practicable management improvements with specific prevention strategies should be developed.

INTRODUCTION: Les conditions d'élevage des lapins en Suisse sont d'un niveau élevé en comparaison internationale. Il est interdit de les garder sur un sol en treillis métallique et leur détention en groupe est obligatoire jusqu'à l'âge de huit semaines. Malgré ces normes d'élevage respectueuses des animaux, les pertes d'animaux semblent être un problème important, les données fiables sur la production professionnelle suisse de lapins de boucherie faisant largement défaut à ce jour. Afin de remédier à cette situation, une enquête d'exploitation a été réalisée dans 52 élevages cunicoles. En parallèle, chaque nouvelle portée et chaque groupe d'engraissement était documenté par le chef d'élevage avec un formulaire standardisé au cours d'une année, l'accent étant principalement mis sur les pertes d'animaux et l'utilisation de médicaments. En cas d'augmentation de la mortalité ou de nouveaux problèmes de santé, les lapins morts étaient envoyés au Centre national de référence pour les maladies de la volaille et des lapins (Zurich) pour une autopsie comprenant des examens bactériologiques et parasitologiques. Les données de 32 entreprises ont pu être évaluées. La mortalité moyenne des jeunes animaux (de la naissance au sevrage) était de 14,9% (1,0­30,0%), celle des lapins à l'engrais (du sevrage à l'abattage) était de 17,3% (4,3­ 31,8%). Les maladies intestinales ont été retrouvées en premier lieu (68,2%), principalement la dysenterie, suivie par la coccidiose intestinale et les entéropathies mucoïdes. Eimeria spp., Escherichia coli et Clostridium perfringens ont été identifiés comme les agents pathogènes les plus fréquents par ordre décroissant. Des maladies respiratoires ont été trouvées chez 18,7% des lapins examinés, le pathogène le plus courant étant Pasteurella multocida. 60,0% des élevages examinés ont utilisé des antibiotiques au cours de la période d'étude, environ un tiers (34,7%) de tous les processus d'engraissement examinés ont été traités avec au moins un antibiotique. Les résultats confirment que les maladies infectieuses et les pertes de lapins en Suisse représentent un problème considérable dans l'élevage professionnel malgré un élevage respectueux des animaux. Afin d'améliorer la santé des lapins dans les entreprises de production professionnelles suisses et de réduire ainsi les taux de mortalité élevés et l'utilisation intensive d'antibiotiques, les facteurs de risque d'augmentation de la morbidité et de la mortalité doivent être déterminés dans une étape supplémentaire afin de développer des améliorations de gestion réalisables dans le cadre de stratégies de prévention spécifiques.

Prevalence and incidence of venous leg ulcers-a protocol for a systematic review.

BACKGROUND: Venous leg ulcers (VLUs) are chronic wounds characterized by slow healing and high recurrence. Information on prevalence and incidence is essential for ascertaining the burden of VLU on the health care system and to inform epidemiological research, priority setting, and health care planning. The objective of this protocol is to present a transparent process for how we plan to review the existing international literature on the prevalence and incidence of VLU as well as the characteristics of the population reported within these studies. METHODS: An exploratory search was performed using MEDLINE via PubMed and CINHAL via Ebsco to identify concepts, keywords, MeSH terms, and headings to identify study types looking at data of VLU prevalence and/or incidence and related patient characteristics. The findings of this exploratory search will determine the final search strategy. The titles and abstracts of the identified articles will be screened independently be two authors for relevance. Study which pass the quality assessment will be included. Data extraction will be performed independently by two authors and in accordance with a pre-designed data extraction form. If the data allows, a meta-analysis will be performed otherwise a descriptive summary of the findings will be conducted. DISCUSSION: The results of this review will contribute to the evidence base on VLU occurrence and may inform the decision making of healthcare professionals, policy-makers, and consumers. It will also inform future research in this area of VLU care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020205855.

Pulsed electron spin resonance spectroscopy in the Purcell regime.

In EPR, spin relaxation is typically governed by interactions with the lattice or other spins. However, it has recently been shown that given a sufficiently strong spin-resonator coupling and high resonator quality factor, the spontaneous emission of microwave photons from the spins into the resonator can become the main relaxation mechanism, as predicted by Purcell. With increasing attention on the use of microresonators for EPR to achieve high spin-number sensitivity it is important to understand how this novel regime influences measured EPR signals, for example the amplitude and temporal shape of the spin-echo. We study this regime theoretically and experimentally, using donor spins in silicon, under different conditions of spin-linewidth and coupling homogeneity. When the spin-resonator coupling is distributed inhomogeneously, we find that the effective spin-echo relaxation time measured in a saturation recovery sequence strongly depends on the parameters for the detection echo. When the spin linewidth is larger than the resonator bandwidth, the different Fourier components of the spin echo relax with different characteristic times - due to the role of the resonator in driving relaxation - which results in the temporal shape of the echo becoming dependent on the repetition time of the experiment.

Magnesium absorption as influenced by the rumen passage kinetics in lactating dairy cows fed modified levels of fibre and protein.

The potassium sensitive magnesium absorption through the rumen wall may be influenced by additional dietary properties, such as diet type, forage type or forage to concentrate ratio. These properties are likely associated to rumen passage kinetics modified by dietary fibre content. The study aimed to assess the effects of rumen passage kinetics on apparent Mg absorption and retention in lactating dairy cows fed modified levels of fibre. Six lactating Red-Holstein and Holstein cows, including four fitted with ruminal cannulas were randomly assigned to a 3 × 3 cross-over design. The experimental diets consisted of early harvested low NDF (341 g NDF/kg DM) and late harvested high NDF (572 g NDF/kg DM) grass silage (80% DM) and of concentrates (20% of DM). As the low-fibre diet was excessive in protein, a third high-fibre diet was formulated to be balanced in digestible protein with the low-fibre diet to avoid any eventual confounding effects of NDF and protein excess. All diets were formulated to contain iso-Ca, -P, -Mg, -K and -Na. Passage kinetics of solid and liquid phase of rumen digesta were evaluated using ruminal marker disappearance profiles. Cows fed the low-fibre diet had compared to the other diets, an up to 40% lower solid and 26% lower liquid phase volume of rumen digesta and a 10% numerically higher fractional rumen liquid passage rate. Rumen pH lost 0.6 units and Mg concentration in the rumen liquid phase tripled when cows were fed the low-fibre diet. Faecal Mg excretion was up to 14% higher in cows fed the low-fibre diet and Mg absorbability was 12% compared to up to 19% in other diets. Urinary Mg excretion in cows fed the low-fibre diet was half of the ones in the other treatments, but Mg retention was not affected. Dietary protein excess neither affected rumen passage kinetics nor Mg absorption and retention. Absorption of Mg was correlated with rumen liquid volume which both decreased with decreasing daily NDF intake (NDFi, 11.8 ± 2.4 l/kg NDFi). Consequently, daily Mg absorption decreased by 1.32 ± 0.28 g/kg decreasing NDFi. To conclude, in addition to the known antagonistic effect of dietary K, the present data indicate that Mg absorption was dependent from NDFi which modified rumen liquid volume, but was independent of dietary protein excess likely associated to low NDF herbages.

Tonicity inversely modulates lipocalin-2 (Lcn2/24p3/NGAL) receptor (SLC22A17) and Lcn2 expression via Wnt/ß-catenin signaling in renal inner medullary collecting duct cells: implications for cell fate and bacterial infection.

BACKGROUND: We have previously evidenced apical expression of the 24p3/NGAL/lipocalin-2 receptor (Lcn2-R; SLC22A17) in inner medullary collecting duct (IMCD) cells, which are present in vivo in a hyperosmotic/-tonic environment that activates canonical Wnt/ß-catenin signaling. The localization of Lcn2-R in the inner medulla is intriguing considering local bacterial infections trigger toll-like receptor-4 (TLR-4)-mediated secretion of the bacteriostatic Fe3+-free (apo-)Lcn2. AIM: To determine the effects of osmolarity/tonicity changes, Wnt/ß-catenin and TLR-4 activation on Lcn2-R and Lcn2 expression and cell viability in rat primary IMCD and mouse (m)IMCD3 cells. METHODS: Normosmolarity/-tonicity was 300 mosmol/l whereas hyperosmolarity/-tonicity was induced by adding 100 mmol/l NaCl + 100 mmol/l urea (600 mosmol/l, 1-7 days). Lcn2-R and Lcn2 expression were determined by qPCR, immunoblotting, flow cytometry and immunofluorescence microscopy. ß-catenin was silenced by RNAi. Cell viability/death was determined with MTT and LDH release assays. TLR-4 was activated by bacterial lipopolysaccharides (LPS). RESULTS: Hyperosmotic/-tonic media upregulated Lcn2-R by ~4-fold and decreased Lcn2 expression/secretion, along with Wnt/ß-catenin activation, in IMCD cells. These effects of hyperosmotic/-tonic media on Lcn2-R/Lcn2 expression were reverted by normosmolarity/-tonicity, ß-catenin silencing and/or LPS. Exposure of cells with endogenous or stably overexpressing Lcn2-R to apo-Lcn2 or LPS decreased cell viability. CONCLUSIONS: Lcn2-R upregulation and Lcn2 downregulation via Wnt/ß-catenin may promote adaptive osmotolerant survival of IMCD cells in response to hyperosmolarity/-tonicity whereas Lcn2 upregulation and Lcn2-R downregulation via TLR-4 and/or normosmolarity/-tonicity may protect IMCD cells against bacterial infections and prevent autocrine death induction by Lcn2.

Performance, body fat reserves and plasma metabolites in Brown Swiss dairy cows: Indoor feeding versus pasture-based feeding.

Feeding dairy cows indoors or on pasture affects not only labour, machinery and housing costs, but also animals' performance and metabolism. This study investigates the effects of indoor feeding (IF) with a partial-mixed ration (PMR) versus pasture-based feeding (PF) on milk production, fertility, backfat thickness (BFT), body weight (BW) loss and energy metabolism of Brown Swiss (BS) dairy cows with similar genetic production potential. The IF herd consisted of 13 cows fed a PMR composed of maize and grass silage plus protein concentrate according to each cow's requirements. The PF herd consisted of 14 cows offered barn-ventilated hay ad libitum after calving from January until March and grazed on semi-continuous pastures during the vegetation period. The IF cows produced more energy-corrected milk (ECM) per standard lactation (9,407 vs. 5,960 kg; p < .01), more milk fat (378 vs. 227 kg; p < .01) and milk protein (326 vs. 215 kg; p < .01). The calving interval (377 vs. 405 days; p < .01) and time empty (86 vs. 118 days; p < .01) were shorter in the PF compared to IF, possibly also due to different selection criteria for maintaining the respective seasonal calving rhythm. The empty body fat loss calculated according to BCS until its nadir was higher in IF cows (IF: 10.4 vs. PF: 4.8 MJ/day; p < .01), but no differences were noted in total body fat loss estimated via BFT (p = .24). However, PF had lower blood glucose concentration at all investigated time points, but no differences occurred in serum non-esterified fatty acid and ß-hydroxybutyrate concentrations post-partum. In conclusion, BS cows were equally well suited for the IF with PMR and the PF system investigated here without developing a prominent metabolic load despite differences in nutrient supply. As such, investigated BS dairy cows in our trial seem to have a high capacity for metabolic adaptation to different production systems.

[Doping relevant substances in horse feed]. / Dopingrelevante Substanzen in Futtermitteln für Pferde.

INTRODUCTION: Horse feed material of Swiss and foreign production available on the Swiss market was tested with regard to possible contamination with 7 different alkaloids, atropine and colchicine. Twenty-eight feed samples as well as 2 poppy seed samples were analyzed. Out of 28 feed samples 18 were positive for prohibited substances in Equestrian sports. The concentration of prohibited substances was in none of the samples high enough to cause an effect on the body of the horse. The poppy seed sample, which was obtained by conventional harvesting and cleaning methods, contained a very high Morphine concentration compared to the sample which was harvested by hand. Despite high quality standards a contamination with prohibited substances in horse feed cannot be excluded.

INTRODUCTION: Divers aliments pour chevaux de provenance indigène et étrangère disponibles sur le marché suisse ont été examinés quant à une éventuelle contamination par 7 alcaloïdes différents ainsi que par l'atropine et la colchicine. On a analysé 28 échantillons de fourrages ainsi que 2 échantillons de graines de pavot provenant de cultures suisses. Dix-huit des vingt-huit échantillons contenaient des substances pouvant avoir une importance en matière de dopage dans les sports équestres. La concentration des substances recherchées n'était, dans aucun des échantillons de fourrages, assez élevée pour qu'on puisse tabler avec un effet sur le corps du cheval. L'échantillon de graines de pavot produites avec les techniques usuelles de récolte et de nettoyage présentait, par rapport à celui composé de graines récoltées à la main, un taux de morphine inhabituellement élevé. La présente étude de 28 échantillons d'aliments démontre qu'une contamination avec des substances ayant une importance en matière de dopage ne peut pas être exclue, même avec des standards de qualité élevés.

Initial autophagic protection switches to disruption of autophagic flux by lysosomal instability during cadmium stress accrual in renal NRK-52E cells.

The renal proximal tubule (PT) is the major target of cadmium (Cd2+) toxicity where Cd2+ causes stress and apoptosis. Autophagy is induced by cell stress, e.g., endoplasmic reticulum (ER) stress, and may contribute to cell survival or death. The role of autophagy in Cd2+-induced nephrotoxicity remains unsettled due to contradictory results and lack of evidence for autophagic machinery damage by Cd2+. Cd2+-induced autophagy in rat kidney PT cell line NRK-52E and its role in cell death was investigated. Increased LC3-II and decreased p62 as autophagy markers indicate rapid induction of autophagic flux by Cd2+ (5-10 µM) after 1 h, accompanied by ER stress (increased p-PERK, p-eIF2α, CHOP). Cd2+ exposure exceeding 3 h results in p62/LC3-II accumulation, but diminished effect of lysosomal inhibitors (bafilomycin A1, pepstatin A +E-64d) on p62/LC3-II levels, indicating decreased autophagic flux and cargo degradation. At 24 h exposure, Cd2+ (5-25 µM) activates intrinsic apoptotic pathways (Bax/Bcl-2, PARP-1), which is not evident earlier (≤6 h) although cell viability by MTT assay is decreased. Autophagy inducer rapamycin (100 nM) does not overcome autophagy inhibition or Cd2+-induced cell viability loss. The autophagosome-lysosome fusion inhibitor liensinine (5 µM) increases CHOP and Bax/Bcl-2-dependent apoptosis by low Cd2+ stress, but not by high Cd2+. Lysosomal instability by Cd2+ (5 µM; 6 h) is indicated by increases in cellular sphingomyelin and membrane fluidity and decreases in cathepsins and LAMP1. The data suggest dual and temporal impact of Cd2+ on autophagy: Low Cd2+ stress rapidly activates autophagy counteracting damage but Cd2+ stress accrual disrupts autophagic flux and lysosomal stability, possibly resulting in lysosomal cell death.

Eomesodermin-At Dawn of Cell Fate Decisions During Early Embryogenesis.

Proteins of the large family of T-box transcription factors are implicated in a broad spectrum of developmental processes. Loss-of-function mutations of T-box(Tbx) factors frequently cause severe embryonic phenotypes, often resulting from defects in cell fate specification and lineage differentiation. This review summarizes current knowledge on the functions of the T-box transcription factor Eomesodermin (Eomes) from postfertilization development until gastrulation stages of vertebrate embryos. Eomes exhibits evolutionary conserved functions in cell lineage specification and morphogenesis during gastrulation in all studied vertebrate model systems. In addition, during mammalian embryogenesis, Eomes is crucially required in extraembryonic tissues that are specific for intrauterine development. This chapter mainly focuses on mammalian development of mouse; however, common functions shared among other vertebrate model system, such as embryos of zebrafish and Xenopus laevis, will be compared in the context of specification cell lineages during gastrulation. Furthermore, this review recapitulates the current understanding of the molecular functions and transcriptional targets of Eomes as component of transcriptional complexes that guide cell-type specification and morphogenesis of early vertebrate embryos.

Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer.

BACKGROUND AND AIMS: With the debate over extent of lymphadenectomy in endometrial cancer, sentinel lymph node (SLN) mapping may provide a focused approach to evaluate the most relevant lymph nodes (LN) while minimizing the complications. We evaluated SLN mapping using filtered technetium(99), indocyanine green (ICG), and blue dye. METHODS: Prospective evaluation of 100 patients who underwent SLN mapping by using submucosal and deep stromal cervical injections of technetium(99), ICG, and blue dye as part of the staging for endometrial cancer. RESULTS: 286 SLNs were mapped (2.9 per patient) in 92% of patients. The bilateral detection rate was 76%. ICG had a significantly higher SLN detection rate than blue dye in both overall (87% vs 71%, respectively; p=0.005) and bilateral (65% vs 43%, respectively; p=0.002) detection, but similar SLN detection rates compared to technetium(99) in both overall (87% vs 88%, respectively; p=0.83) and bilateral (65% vs 71%, respectively; p=0.36) detection. In eight cases, the SLN was in the para-aortic area and in 14 cases in the pre-sacral, hypogastric vein, or parametrial area. In nine cases, the SLN was positive for metastasis, and in seven cases the SLN was the only positive node. One SLN was falsely negative. No complications or anaphylactic reactions occurred. CONCLUSION: Intra-operative SLN mapping using cervical injection is feasible in patients with endometrial cancer and yields adequate detection rates. It allows mapping of SLNs in areas (pre-sacral, hypogastric vein, parametrial) not routinely sampled. Given the poorer performance of blue dye, surgeons may omit its use if a combination of ICG and technetium(99) is used.

Efficient and robust analysis of complex scattering data under noise in microwave resonators.

Superconducting microwave resonators are reliable circuits widely used for detection and as test devices for material research. A reliable determination of their external and internal quality factors is crucial for many modern applications, which either require fast measurements or operate in the single photon regime with small signal to noise ratios. Here, we use the circle fit technique with diameter correction and provide a step by step guide for implementing an algorithm for robust fitting and calibration of complex resonator scattering data in the presence of noise. The speedup and robustness of the analysis are achieved by employing an algebraic rather than an iterative fit technique for the resonance circle.

[Perioperative evaluation and treatment of cardiovascular risk patients for noncardiac surgery : Guidelines of the European Society of Cardiology/European Society of Anaesthesiology 2014]. / Perioperative Beurteilung und Behandlung kardiovaskulärer Risikopatienten für nichtherzchirurgische Eingriffe : Leitlinien 2014 der European Society of Cardiology/European Society of Anaesthesiology.

In late summer 2014, the joint working group of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) presented new guidelines for the evaluation and treatment of cardiovascular risk patients undergoing noncardiac surgery. In addition to the preoperative collation of patient and intervention-specific risks, the guidelines deal with anaesthesiological and cardiological aspects of the perioperative management of patients with diseases of the heart and common comorbidities. This article summarizes the essential aspects of the guidelines in a clearly arranged form.

Coping with an exulcerated breast carcinoma: an interpretative phenomenological study.

OBJECTIVE: To explore how women living at home with a malignant fungating wound (MFW) cope with such wounds. METHOD: To explore coping through the lived experiences of patients a methodological framework, using Heideggerian hermeneutic phenomenology and semi-structured interviews. Nine patients were interviewed from January until November 2009. RESULTS: The results are divided into two categories: 'living with a MFW' and 'feeling different'. These categories demonstrate how it is to live with the unpredictability, and uncontrollability of a MFW due to symptoms such as malodour, bleeding, exudate, pain and itching. The loss of control of the body boundary due to uncontrollable symptoms led to significant levels of distress and suffering for the patients. Different coping strategies were used to live with this wound. CONCLUSION: This study demonstrates how difficult it is to live and cope with a malignant fungating wound. Coping strategies, including going into isolation, or denying any issues, were used. When taking care of patients with MFWs, strategies need to integrate a palliative, holistic, empathic approach.

Antimicrobials and Non-healing Wounds Evidence, controversies and suggestions.

Non-healing wounds are a significant problem for health-care systems worldwide. In the industrialised world, almost 1-1.5% of the population will have a problem wound at any one time. Furthermore, wound management is expensive; in Europe, the average cost per episode is 6650 euros for leg ulcers and 10 000 euros for foot ulcers, and wound management accounts for 2-4% of health-care budgets. These figures are expected to rise along with an increased elderly and diabetic population.1-4.

Anisotropic rare-earth spin ensemble strongly coupled to a superconducting resonator.

Interfacing photonic and solid-state qubits within a hybrid quantum architecture offers a promising route towards large scale distributed quantum computing. Ideal candidates for coherent qubit interconversion are optically active spins, magnetically coupled to a superconducting resonator. We report on an on-chip cavity QED experiment with magnetically anisotropic Er(3+)∶Y2SiO5 crystals and demonstrate collective strong coupling of rare-earth spins to a lumped element resonator. Moreover, the electron spin resonance and relaxation dynamics of the erbium spins are detected via direct microwave absorption, without the aid of a cavity.

Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie.

BACKGROUND: The combination of docetaxel (Taxotere), cisplatin, and fluorouracil improved efficacy in gastric cancer, but was associated with substantial toxicity. This study was designed to incorporate docetaxel into a tolerable biweekly (once every 2 weeks) oxaliplatin-based chemotherapy regimen. PATIENTS AND METHODS: Patients with measurable, metastatic adenocarcinoma of the stomach or esophagogastric junction and no prior chemotherapy received oxaliplatin 85 mg/m(2), leucovorin 200 mg/m(2), and fluorouracil 2600 mg/m(2) as a 24-h infusion in combination with docetaxel 50 mg/m(2) (FLOT) on day 1 every 2 weeks. Prophylactic growth factors were not administered. RESULTS: Fifty-nine patients were enrolled; 54 received treatment. Patients had a median age of 60 years (range 29-76) and most (93%) of them had metastatic disease. Objective responses were observed in 57.7% of patients with a median time to treatment response of 1.54 months. Median progression-free survival (PFS) and overall survival were 5.2 and 11.1 months, respectively. Twenty-five percent of patients experienced prolonged (>12 months) PFS. Frequent (>10%) grade 3 or 4 toxic effects included neutropenia in 26 (48.1%), leukopenia in 15 (27.8%), diarrhea in 8 (14.8%), and fatigue in 6 (11.1%) patients. Complicated neutropenia was observed in two (3.8%) patients, only. CONCLUSIONS: Biweekly FLOT is active and has a favorable safety profile.