Asthma app use and interest among patients with asthma: a multicenter study

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Calidad de vida relacionada con la salud en pacientes oncológicos con enfermedad tromboembólica venosa aguda sintomática. Diseño del estudio qca (quality of life in cancer). Estudio de casos y controles / Health-related quality of life in cancer patients with acute symptomatic venous thromboembolic disease. Design of the QCa (quality of life in cancer) study. Case-control study

La asociación entre cáncer y enfermedad tromboembólica (ETV) se encuentra bien establecida. La ETV presenta una elevada morbimortalidad, objetivándose un incremento del riesgo de ETV hasta 4 veces mayor en aquellos pacientes con cáncer respecto a la población general. Sin embargo, existe poca evidencia científica sobre la CVRS (calidad de vida relacionada con la salud) en pacientes oncológicos con ETV, cuando es presumible que esta patología suponga un agravante sobre la percepción del estado de salud de los pacientes oncológicos. Nuestro objetivo es presentar el estudio "QCa Study", el cual pretende evaluar la CVRS de los pacientes oncológicos con ETV aguda sintomática en comparación con pacientes oncológicos sin ETV. "QCa study" es un estudio nacional de cohortes, prospectivo, de casos y controles en pacientes con cáncer activo. Definimos "caso" como aquel paciente oncológico con ETV aguda sintomática, y "control" aquel paciente oncológico sin ETV aguda sintomática. Los criterios de inclusión son: para los casos: presentar cáncer activo al momento de la inclusión. Tener más de 18 años, pacientes diagnosticados de trombosis venosa profunda (TVP) en miembros inferiores aguda sintomática o de embolia de pulmón (EP) confirmado de forma objetiva mediante pruebas de imagen y firma del consentimiento informado. Para los controles; presentar cáncer activo. Tener más de 18 años. Firma del consentimiento informado. Dado los escasos datos publicados respecto a la CVRS en pacientes con ETV, hemos diseñado el estudio Qca, para poder determinar el impacto que genera la ETV en la calidad de vida de los pacientes con cáncer

The association between cancer and venous thromboembolic disease (VTD) is well established. VTD presents a high rate of morbidity and mortality, with patients with cancer showing an increased risk of VTD that is up to 4 times greater than the general population. However, there is little scientific evidence on HRQoL (health-related quality of life) in cancer patients with VTD when this disease is likely to be an aggravating factor in perceived state of health among cancer patients. Our objective is to present the QCa study, which aims to evaluate the HRQoL of cancer patients with acute symptomatic VTD in comparison with cancer patients without VTD. The QCa study is a prospective, case-control national cohort study in patients with active cancer. We define "case" as a cancer patient with acute symptomatic VTD and "control" as a cancer patient without acute symptomatic VTD. Inclusion criteria for cases were: having active cancer at the time of inclusion, being over the age of 18, patients diagnosed with acute symptomatic deep vein thrombosis (DVT) in the lower extremities or pulmonary embolism (EP) that was objectively confirmed through imaging tests, and having signed the informed consent. For the controls: having active cancer, being over the age of 18, and having signed the informed consent. Given the scarce data published with regard to HRQoL in patients with VTD, we designed the QCa study to determine the impact VTD has on the quality of life of patients with cancer

Association between type of feeding at discharge from the hospital and nutritional status of very low birth weight preterm infants

The ideal feeding for premature babies has been the source of extensive debate. The aim of this study was to assess the association between type of feeding at discharge and the nutritional status of very low birth weight infants. This was a retrospective cohort of preterm babies with birth weight ≤1500 g, born between January 2006 and December 2013. The infants were divided into 3 groups according to type of feeding at discharge: exclusive breast milk (group 1), mixed feeding (group 2) and exclusive artificial formula (group 3). Frequencies of each group were calculated, as well as mean Z-score differences in weight, length and head circumference. Six hundred and forty-nine newborns were included. The mean weight of groups 1, 2, and 3 was 1338.7, 1104.0, and 1254.7 g, respectively, and their mean gestational age was 31.9, 30, and 31.2 weeks, respectively. The Z-score differences (means±SD) for groups 1, 2, and 3 were: −0.84±0.68, −1.02±0.75, and −0.86±0.71 for weight, −0.21±1.23, −0.52±1.64 and −0.08±1.34 for head circumference, and −1.10±1.18, −1.54±1.37, and −0.97±1.21 for length. A significant difference was observed between groups 2 and 3 in the adjusted Z-score model for length, with no significant differences in anthropometric measurements for the other comparative analyses. Because of its many advantages, breastfeeding should be stimulated within neonatal units since nutritional status was not influenced by the different types of feeding.

Stereotactic radiosurgery and stereotactic fractionated radiotherapy for metastatic tumors of the spine.

OBJECTIVES: The objectives of this paper are to describe pain control, neurologic improvement, local tumor control, progression-free survival, and overall survival of spine SRS/SFRT patients, and to compare our outcomes with other studies on spine stereotactic radiotherapy for metastatic tumors. METHODS: A chart review of patients who underwent spine SRS/SFRT was done. Information was collected on patient age, sex, histology, site treated, pain relief, local control, neurologic function, prescription dose, and complications. Descriptive statistics, median local control rates, progression-free survival, and overall survival were calculated. RESULTS: Twenty eight SRS and 3 SFRT target volumes in 21 patients were studied. Eighteen underwent SRS and 3 underwent SFRT for metastasis from August 2012 to February 2016. Follow-up ranged from 4 to 41 months. Average dose was 16.6 ± 3.9 Gy. Spine SRS mean target volume was 31.1 cc (95% CI, 21.7-40.6 cc). Median overall survival after treatment was 16 months (95% CI, 9.7-22.3 months) and median progression-free survival was 13 months (95% CI, 8.4-17.6 months). Local control was 46%, 30%, and 15% at 6, 8, and 10 months, respectively. Average onset of pain relief is 4.9 days (95% CI, 0.8-8.9 days). One patient (5%) developed post SRS vertebral compression fracture. CONCLUSION: SRS/SFRT is a safe and effective alternative to EBRT for the treatment of spine metastasis. Improvement in pain control and motor strength and incidence of adverse events are comparable with other studies. Local tumor control was lower in our series due to a lower mean prescribed dose.

Plantas medicinais com ação antiparasitária: conhecimento tradicional na etnia Kantaruré, aldeia Baixa das Pedras, Bahia, Brasil / Medicinal plants with antiparasitic action: traditional knowledge of the Kantaruré ethnic group, Baixa das Pedras village, Bahia, Brazil

RESUMO O uso de espécies vegetais para curar doenças e sintomas remonta ao início da civilização. Em várias culturas produtos botânicos eram empregados para essa finalidade. No Brasil, sob influência das interações culturais entre índios, negros e portugueses, essa relação homem-natureza permitiu a disseminação da sabedoria herdada em relação ao uso e cultivo de diversas espécies vegetais. O presente trabalho objetivou realizar um levantamento das plantas medicinais indicadas pelos índios da etnia Kantaruré, aldeia Baixa das Pedras com ação antiparasitária. Para a coleta de dados foram realizadas entrevistas semiestruturadas com quatorze pessoas, pertencentes a uma população de 150 indígenas, selecionadas pela técnica da bola de neve, reconhecidas pela comunidade como maiores detentores do conhecimento sobre a realidade local e sobre plantas. Os resultados indicam que doze espécies são utilizadas na medicina tradicional local com ação antiparasitária, podendo destacar a caçatinga (Croton argyrophylloides Muell. Arg.), mastruz (Chenopodium ambrosioides L.), hortelã miúdo (Mentha piperita L.) e babosa (Aloe vera (L.) Burm f.) como as mais indicadas. As plantas citadas pertencem à vegetação nativa, sendo que as espécies cultivadas são encontradas principalmente nos quintais, nas proximidades das residências e em locais de cultivo próprio. Os dados levantados nesta pesquisa evidenciam a importância terapêutica, cultural e histórica do uso de espécies botânicas na prevenção e cura de enfermidades. A aldeia estudada depende diretamente dos recursos vegetais para as suas práticas de cura. Os resultados dessa pesquisa podem servir como base para bioprospecção bem como para seleção de espécies da caatinga para estudos futuros visando o seu uso e manejo sustentável.

ABSTRACT The use of plant species to cure diseases and symptoms dates back to the dawn of civilization. In various cultures, botanical products were employed for this purpose. In Brazil, influenced by cultural interactions between native indians, Africans, and the Portuguese, this man-nature relationship allowed the spread of inherited knowledge regarding the use and cultivation of various species of plants. The purpose of this study was to carry out a survey of medicinal plants with antiparasitic action indicated by the Kantaruré indians from the Baixa das Pedras village. For data collection, semi-structured interviews were conducted with 14 people belonging to an indigenous population of 150, selected by the snowball technique, recognized by the community as the most knowledgeable on the local situation and plants. The results indicate that 12 species with antiparasitic action are used in traditional local medicine, with emphasis on the caçatinga (Croton argyrophylloides Muell. Arg.), mastruz (Chenopodium ambrosioides L.), peppermint (Mentha piperita L.), and babosa (Aloe vera (L.) Burm f.) as the most suitable. These plants belong to the native vegetation, and the cultivated species are found mainly in backyards, near homes, and on cultivation sites. The data from this study demonstrate the therapeutic, cultural, and historical importance of the use of botanical species to prevent and cure diseases. The village studied depends directly on plant resources for their healing practices. The results of this study can serve as a basis for bioprospecting as well as for the selection of caatinga species in future studies toward its use and sustainable management.

Diffusive emission of methane and carbon dioxide from two hydropower reservoirs in Brazil / Emissões difusivas de metano e de dióxido de carbono oriundas de dois reservatórios hidrelétricos

The role of greenhouse gas emissions from freshwater reservoirs and their contribution to increase greenhouse gas concentrations in the atmosphere is currently under discussion in many parts of the world. We studied CO2 and CH4 diffusive fluxes from two large neotropical hydropower reservoirs with different climate conditions. We used floating closed-chambers to estimate diffusive fluxes of these gaseous species. Sampling campaigns showed that the reservoirs studied were sources of greenhouse gases to the atmosphere. In the Serra da Mesa Reservoir, the CH4 emissions ranged from 0.530 to 396.96 mg.m–2.d–1 and CO2 emissions ranged from –1,738.33 to 11,166.61 mg.m–2.d–1 and in Três Marias Reservoir the CH4 fluxes ranged 0.720 to 2,578.03 mg.m–2.d–1 and CO2 emission ranged from -3,037.80 to 11,516.64 to mg.m–2.d–1. There were no statistically significant differences of CH4 fluxes between the reservoirs, but CO2 fluxes from the two reservoirs studied were significantly different. The CO2 emissions measured over the periods studied in Serra da Mesa showed some seasonality with distinctions between the wet and dry transition season. In Três Marias Reservoir the CO2 fluxes showed no seasonal variability. In both reservoirs, CH4 emissions showed a tendency to increase during the study periods but this was not statistically significant. These results contributed to increase knowledge about the magnitude of CO2 and CH4 emission in hydroelectric reservoirs, however due to natural variability of the data future sampling campaigns will be needed to better elucidate the seasonal influences on the fluxes of greenhouse gases.

Atualmente, em diversas partes do mundo, tem-se discutido muito sobre a contribuição das emissões de gases de efeito estufa oriundas de reservatórios hidrelétricos. Neste trabalho foram medidos fluxos difusivos de CO2 e CH4 em dois grandes reservatórios hidrelétricos neotropicais com diferentes condições climáticas (UHE Serra da Mesa e UHE Três Marias). Utilizamos câmaras flutuantes para estimar os fluxos difusivos de CO2 e CH4. As campanhas de amostragem mostraram que os dois reservatórios estudados apresentaram-se como fontes emissoras de gases por mecanismo de difusão. No reservatório de Serra da Mesa as emissões de CH4 variaram entre 0,530 e 396,96 mg.m–2.d–1 e as emissões de CO2 variaram entre –1.738,33 a 11.166,61 mg.m–2.d–1. No reservatório de Três Marias os fluxos de CH4 variaram entre 0,720 e 2.578,03 mg.m–2.d–1. Já os fluxos de CO2 variaram de -3.037,80 à 11.516,64 mg.m–2.d–1. Não houve diferença estatisticamente significativa dos fluxos de CH4 entre os reservatórios estudados, entretanto os fluxos de CO2 foram significativamente diferentes. As emissões de CO2 medidas ao longo dos períodos estudados em Serra da Mesa mostrou certa sazonalidade, com distinções entre o período de transição seco e úmido. No reservatório de Três Marias os fluxos de CO2 não apresentaram variabilidade sazonal. Em ambos os reservatórios, as emissões de CH4 apresentaram aumento do fluxo ao longo dos períodos de estudo, mas isso não foi estatisticamente significativo. Estes resultados contribuíram para aumentar o conhecimento sobre a variabilidade das emissões difusivas de CO2 e CH4 em reservatórios de usinas hidrelétricas. Entretanto, novas campanhas de amostragem serão necessárias para melhor estudar as influências sazonais sobre os fluxos dos gases de efeito estufa.

Clinical features, etiology and outcomes of community-acquired pneumonia in patients with chronic obstructive pulmonary disease.

BACKGROUND: Community-acquired pneumonia (CAP) is a frequent complication of chronic obstructive pulmonary disease (COPD), but previous studies are often contradictory. OBJECTIVES: We aimed to ascertain the characteristics and outcomes of CAP in patients with COPD as well as to determine the risk factors for mortality and Pseudomonas aeruginosa pneumonia in COPD patients with CAP. We also describe the etiology and outcomes of CAP in COPD patients receiving chronic oxygen therapy at home and those receiving inhaled steroids. METHODS: An observational analysis of a prospective cohort of hospitalized adults with CAP (1995-2011) was performed. RESULTS: We documented 4121 CAP episodes, of which 983 (23.9%) occurred in patients with COPD; the median FEV1 value was 50%, and 57.8% were classified as stage III or IV in the GOLD classification. Fifty-eight per cent of patients were receiving inhaled steroids, and 14.6% chronic oxygen therapy at home. Patients with COPD presented specific clinical features. S. pneumoniae was the leading causative organism overall, but P. aeruginosa was more frequent in COPD (3.4 vs. 0.5%; p<0.001). Independent risk factors for case-fatality rate in patients with COPD were multilobar pneumonia, P. aeruginosa pneumonia, and high-risk PSI classes. Prior pneumococcal vaccination was found to be protective. FEV1 was an independent risk factor for P. aeruginosa pneumonia. CONCLUSIONS: CAP in patients with COPD presents specific characteristics and risk factors for mortality. Prior pneumococcal vaccine has a beneficial effect on outcomes. P. aeruginosa pneumonia is associated with low FEV1 values and poor prognosis.

Coenzyme Q10 supplementation improves metabolic parameters, liver function and mitochondrial respiration in rats with high doses of atorvastatin and a cholesterol-rich diet.

BACKGROUND: The aim of this study was to evaluate the actions of coenzyme Q10 (CoQ10) on rats with a cholesterol-rich diet (HD) and high doses of atorvastatin (ATV, 0.2, 0.56 or 1.42 mg/day). METHODS: Two experiments were done, the first one without coenzyme Q10 supplementation. On the second experiment all groups received coenzyme Q10 0.57 mg/day as supplement. After a 6-week treatment animals were sacrificed, blood and liver were analyzed and liver mitochondria were isolated and its oxygen consumption was evaluated in state 3 (phosphorylating state) and state 4 (resting state) in order to calculate the respiratory control (RC). RESULTS: HD increased serum and hepatic cholesterol levels in rats with or without CoQ10. ATV reduced these values but CoQ10 improved even more serum and liver cholesterol. Triacylglycerols (TAG) were also lower in blood and liver of rats with ATV + CoQ10. HDL-C decreased in HD rats. Treatment with ATV maintained HDL-C levels. However, these values were lower in HD + CoQ10 compared to control diet (CD) + CoQ10. RC was lessened in liver mitochondria of HD. The administration of ATV increased RC. All groups supplemented with CoQ10 showed an increment in RC. In conclusion, the combined administration of ATV and CoQ10 improved biochemical parameters, liver function and mitochondrial respiration in hypercholesterolemic rats. CONCLUSIONS: Our results suggest a potential beneficial effect of CoQ10 supplementation in hypercholesterolemic rats that also receive atorvastatin. This beneficial effect of CoQ10 must be combined with statin treatment in patient with high levels of cholesterol.

A phase I, dose-finding study of sorafenib in combination with gemcitabine and radiation therapy in patients with unresectable pancreatic adenocarcinoma: a Grupo Español Multidisciplinario en Cáncer Digestivo (GEMCAD) study.

PURPOSE: Sorafenib, an oral inhibitor of B-raf, VEGFR2, and PDGFR2-beta, acts against pancreatic cancer in preclinical models. Due to the radio-sensitization activity of both sorafenib and gemcitabine, we designed a multicenter, phase I trial to evaluate the safety profile and the recommended dose of this combination used with concomitant radiation therapy. METHODS: Patients with biopsy-proven, unresectable pancreatic adenocarcinoma (based on vascular invasion detected by computed tomography) were treated with gemcitabine (300 mg/m2 i.v. weekly ×5 weeks) concurrently with radiation therapy (45 Gy in 25 fractions) and sorafenib (escalated doses in a 3+3 design, from 200 to 800 mg/day). Radiation portals included the primary tumor but not the regional lymph nodes. Patients with planning target volumes (PTV) over 500 cc were excluded. Cases not progressing during chemoradiation were allowed to continue with sorafenib until disease progression. RESULTS: Twelve patients were included. Three patients received 200 mg/day, 6 received 400 mg/day, and 3 received 800 mg/day; PTVs ranged from 105 to 500 cc. No dose-limiting toxicities occurred. The most common grade 2 toxicities were fatigue, neutropenia, nausea, and raised serum transaminases. Treatment was discontinued in one patient because of a reversible posterior leukoencephalopathy. There were no treatment-related deaths. CONCLUSION: The addition of sorafenib to concurrent gemcitabine and radiation therapy showed a favorable safety profile in unresectable pancreatic adenocarcinoma. A dose of 800 mg/day is recommended for phase II evaluation. TRIAL REGISTRATION: EudraCT 2007-003211-31 ClinicalTrials.gov 00789763.

Intra-operative electron beam radiotherapy for newly dignosed and recurrent malignant gliomas: feasibility and lon-term outcomes

INTRODUCTION: Intra-operative electron beam radiotherapy (IOERT) is an alternative to dose escalation for the treatment of central nervous system tumors. The objective of this study was to describe the feasibility and long-term outcomes of IOERT in the treatment of primary and recurrent gliomas. MATERIALS AND METHODS: From January 1992 through December 2002, all patients treated with IOERT at the Hospital San Francisco de Asis, Madrid/Spain were retrospectively reviewed. The selection criteria included patients with superficial tumors, KPS >70 % and lesions <6 cm. Irradiation was administered in one section. The prescribed dose considered the amount of post-resection residual tumor, previous radiotherapy and the tolerance level of brain structures exposed to IOERT. RESULTS: There were 17 patients (53 %) with newly diagnosed malignant brain gliomas and 15 patients with recurrent tumors. The delivered dose varied from 8 to 20 Gy (median 12.5 Gy) for primary and from 8 to 16 Gy (median 10 Gy) for recurrent tumors. The median overall survival for the entire cohort was 13 months (14 and 10.4 months for the primary and recurrent, respectively). Three patients presented with radionecrosis, one patient with osteomyelitis at the craniotomy bone flap, one with intracerebral hemorrhage, and another patient experienced a pulmonary embolism. CONCLUSIONS: IOERT is a feasible technique and can be viewed as a tool in the treatment of newly diagnosed or recurrent brain gliomas (AU)

Product design enhancement using apparent usability and affective quality.

In this study, apparent usability and affective quality were integrated in a design framework called the Usability Perception and Emotion Enhancement Model (UPEEM). The UPEEM was validated using structural equation modeling (SEM). The methodology consists of four phases namely product selection, attribute identification, design alternative generation, and design alternative evaluation. The first stage involved the selection of a product that highly involves the consumer. In the attribute identification stage, design elements of the product were identified. The possible values of these elements were also determined for use in the experimentation process. Design of experiments was used to identify how the attributes will be varied in the design alternative stage and which of the attributes significantly contribute to affective quality, apparent usability, and desirability in the design evaluation stage. Results suggest that product attributes related to form are relevant in eliciting intense affect and perception of usability in mobile phones especially those directly related to functionality and aesthetics. This study considered only four product attributes among so many due to the constraints of the research design employed. Attributes related to aesthetic perception of a product enhance apparent usability such as those related to dimensional ratios.