Advanced thymic carcinoma with a hepatic metastasis treated with chemotherapy and staged resection.

Thymic carcinoma is rare, with resulting treatment of patients with extrathoracic metastasis being on a case-by-case basis. We describe the management of a woman in her 70s with an incidentally discovered cystic hepatic lesion with confirmation of a solitary extrathoracic metastasis from a synchronous primary thymic carcinoma. Following chemotherapy and staged resection of the metastasis and the primary tumour, the patient remained free of disease on radiological surveillance 6 months postoperatively.

Sustained proton pump inhibitor deprescribing among dyspeptic patients in general practice: a return to self-management through a programme of education and alginate rescue therapy. A prospective interventional study.

BACKGROUND: Dyspepsia guidelines recommend that patients treated with proton pump inhibitors (PPIs) should step down to the lowest effective dose or return to self-care, but rebound hyperacidity can make this difficult. Many patients continue on PPIs in the long term, which may lead to safety and financial implications. AIM: To determine if a nurse-led educational support programme and rescue therapy for rebound symptoms can help patients achieve a sustained reduction in PPI use. DESIGN & SETTING: A prospective interventional study was conducted at 26 surgeries across the UK. METHOD: Adult patients, treated with PPIs for ≥2 consecutive months with an active repeat prescription, were invited to a 20-minute dyspepsia clinic appointment with a trained nurse adviser. An action plan to reduce and/or stop their PPI usage was agreed and alginate supplied for the self-management of rebound symptoms. After 12 months, PPI status was reviewed and prescribing cost savings calculated. RESULTS: After 12 months, 75.1% of 6249 eligible patients stepped down or off PPIs (35.3% stepped off; 5.0% stepped down then off; 34.8% stepped down only), while 8.7% of patients had reverted to their original PPI dose. PPI prescriptions fell from 89 915 to 45 880 and alginate prescriptions increased from 2405 to 6670. An average of 1.7 bottles (500 ml each) of alginate were used per patient who stepped down or off. Estimated annual cost-saving on prescriptions was £31 716.30. CONCLUSION: A programme of education and short-term rebound symptom management helped the majority of patients to successfully step down or off PPIs, significantly reducing the potential risks associated with chronic therapy.

Physio-behavioral coupling in a cooperative team task: contributors and relations.

Research indicates that coactors performing cooperative tasks often exhibit spontaneous and unintended similarities in their physiological and behavioral responses--a phenomenon referred to here as physio-behavioral coupling (PBC). The purpose of this research was to identify contributors to PBC; examine relationships between PBC, team performance, and perceived team attributes (e.g., cohesion, trust); and compare a set of time-series measures(cross-correlation [CC], cross-recurrence quantification analysis [CRQA], and cross-fuzzy entropy [CFEn]) in their characterization of PBC across comparisons. To accomplish this, PBC was examined in human postural sway (PS) and cardiac interbeat intervals (IBIs) from dyadic teams performing a fast-paced puzzle task (Quadra--a variant of the video game Tetris). Results indicated that observed levels of PBC were not a chance occurrence, but instead driven by features of the team-task environment, and that PBC was likely influenced by similar individual task demands and interpersonal coordination dynamics that were not "unique" to a particular team. Correlation analysis revealed that PBC exhibited negative relationships with team performance and team attributes, which were interpreted to reflect complementary coordination (as opposed to mimicry) during task performance, potentially due to differentiated team roles. Finally, qualitative comparison of time-series measures used to characterize PBC indicated that CRQA percent recurrence and CFEn (both nonlinear measures) settled on mostly analogous characterizations, whereas linear CC did not. The disparity observed between the linear and nonlinear measures highlights underlying computational and interpretational differences between the two families of statistics and supports the use of multiple metrics for characterizing PBC.

Incretin-based therapies for type 2 diabetes mellitus: a review of direct comparisons of efficacy, safety and patient satisfaction.

BACKGROUND: Clinical trials comparing incretin-based therapies-glucagon-like peptide-1 receptor agonists (exenatide-twice daily and once weekly-and once-daily liraglutide) and dipeptidyl peptidase-4 inhibitors (vildagliptin, sitagliptin, saxagliptin and linagliptin)-with placebo and oral antidiabetic drugs show that these therapies effectively control glycaemia, with low risk of hypoglycaemia. Glucagon-like peptide-1 receptor agonists are associated with weight loss and reductions in systolic blood pressure, while dipeptidyl peptidase-4 inhibitors are weight-neutral. Based on this, the National Institute for Health and Clinical Excellence recommends using these agents in patients with type 2 diabetes for whom excess weight and/or hypoglycaemia are problematic. AIM OF THE REVIEW: This review aims to help decision making when selecting and using incretin-based therapies in type 2 diabetes. METHODS: A search or MEDLINE and Cochrane clinical trials databases, limited to clinical trials in humans, was performed using the search criteria 'exenatide or liraglutide or vildagliptin or sitagliptin, or saxagliptin or linagliptin'. Abstracts presented at recent American Diabetes Association and European Association for the Study of Diabetes meetings were also searched. Eighteen clinical trials directly comparing incretin-based therapies were identified. RESULTS: Glucagon-like peptide-1 receptor agonists achieved significantly greater reductions in glycated hemoglobin and weight than dipeptidyl peptidase-4 inhibitors, which have a neutral effect on weight. Between-treatment differences were clinically important. Gastrointestinal side effects were more frequent with glucagon-like peptide-1 receptor agonists versus dipeptidyl peptidase-4 inhibitors. Comparisons between glucagon-like peptide-1 receptor agonists and between dipeptidyl peptidase-4 inhibitors showed that differences within the available agents in the two sub-classes are small. Greater treatment satisfaction was reported with glucagon-like peptide-1 receptor agonists versus dipeptidyl peptidase-4 inhibitors. CONCLUSION: Glucagon-like peptide-1 receptor agonists achieve greater glycated hemoglobin reductions than dipeptidyl peptidase-4 inhibitors, with concomitant weight loss. Probably due to the greater efficacy of glucagon-like peptide-1 receptor agonists, patient satisfaction is greater with these agents compared with dipeptidyl peptidase-4 inhibitors despite injectable versus oral administration and more frequent gastrointestinal side effects with the agonists.

Wide-field Fizeau imaging telescope: experimental results.

A nine-aperture, wide-field Fizeau imaging telescope has been built at the Lockheed-Martin Advanced Technology Center. The telescope consists of nine, 125 mm diameter collector telescopes coherently phased and combined to form a diffraction-limited image with a resolution that is consistent with the 610 mm diameter of the telescope. The phased field of view of the array is 1 murad. The measured rms wavefront error is 0.08 waves rms at 635 nm. The telescope is actively controlled to correct for tilt and phasing errors. The control sensing technique is the method known as phase diversity, which extracts wavefront information from a pair of focused and defocused images. The optical design of the telescope and typical performance results are described.