Cancer screening - principles, evaluation and implementation

Screening for malignant disease aims to reduce the population risk of impaired health due to the tumor in question. Screening does not only entail testing but covers all steps required to achieve the intended reduction in risk, from the appropriate information of the population to a suitable therapy. Screening tests are performed in individuals free or unaware of any symptoms associated with the tumor. An essential condition is a recognizable pathological abnormality, which occurs without symptoms and represents a pre-clinical, early stage of the tumor. Overdiagnosis and overtreatment have only recently been recognized as important problems of screening for malignant disease. Overdiagnosis is defined as a screening-detected tumor that would never have led to symptoms. In prostate-specific antigen (PSA) screening for prostate cancer 50 % - 70 % of screening-detected cancers represent such overdiagnoses. Similarly, in the case of mammography screening 20 % - 30 % of screening-detected breast cancers are overdiagnoses. The evaluation of screening interventions is often affected by biases such as healthy screenee effects or length and lead time bias. Randomized controlled trials are therefore needed to examine the efficacy and effectiveness of screening interventions and to define the rate of adverse outcomes such as unnecessary diagnostic evaluations, overdiagnosis and overtreatment. Unfortunately there is no independent Swiss body comparable to the National Screening Committee in the United Kingdom or the United States Preventive Services Task Force, which examines screening tests and programs and develops recommendations. Clearly defined goals, a central organization responsible for inviting eligible individuals, documentation and quality assurance and balanced information of the public are important attributes of successful screening programs. In Switzerland the establishment of such programs is hampered by the highly fragmented, Federal health system which allows patients to access specialists directly.

Clinical outcomes following subgingival application of a novel erythritol powder by means of air polishing in supportive periodontal therapy: a randomized, controlled clinical study

OBJECTIVES The aim of this prospective, randomized, controlled clinical study was to compare the clinical outcomes of the subgingival treatment with erythritol powder by means of an air-polishing (EPAP) device and of scaling and root planing (SRP) during supportive periodontal therapy (SPT). METHOD AND MATERIALS 40 patients enrolled in SPT were randomly assigned to two groups of equal size. Sites had to show signs of inflammation (bleeding on probing [BOP]-positive) and a probing pocket depth (PPD) of ≥ 4 mm, however, without presence of detectable subgingival calculus. During SPT, these sites were treated with EPAP or SRP, respectively. Full mouth and site-specific plaque indices, BOP, PPD, and clinical attachment level (CAL) were recorded at baseline (BL) and at 3 months, whereas the percentage of study sites positive for BOP (BOP+) was considered as primary outcome variable. Additionally, patient comfort using a visual analog scale (VAS) and the time needed to treat per site was evaluated. RESULTS At 3 months, mean BOP level measured 45.1% at test sites and 50.6% at control sites, respectively, without a statistically significant difference between the groups (P > .05). PPD and CAL slightly improved for both groups with comparable mean values at 3 months. Evaluation of patient tolerance showed statistically significantly better values among patients receiving the test treatment (mean VAS [0-10], 1.51) compared to SRP (mean VAS [0-10], 3.66; P = .0012). The treatment of test sites was set to 5 seconds per site. The treatment of control sites, on the other hand, lasted 85 seconds on average. CONCLUSION The new erythritol powder applied with an air-polishing device can be considered a promising modality for repeated instrumentation of residual pockets during SPT. CLINICAL RELEVANCE With regard to clinical outcomes during SPT, similar results can be expected irrespective of the two treatment approaches of hand instrumentation or subgingival application of erythritol powder with an air-polishing device in sites where only biofilm removal is required.

Dental phobia is no contraindication for oral implant therapy

OBJECTIVES Dental phobia is a psychological disease and a possible contraindication for implant therapy. The study aimed to show that implant therapy in dental-phobic patients (DP, test group) after adequate psychological and dental pretreatment (PDPT) is successfully possible and results in a similar implant prognosis as in nonfearful patients (NF, control group). METHOD AND MATERIALS 15 DP with PDPT and 15 NF were treated with dental implants and were re-evaluated 2 to 4 years after denture-mounting regarding: alteration of dental anxiety (Hierarchical Anxiety Questionnaire [HAQ], Visual Analog Scale [VAS]), patient satisfaction and compliance, implant success, and peri-implant health. Statistical tests of non-inferiority DP versus NF were performed with Hodges-Lehmann estimators and respective one-sided 97.5% confidence intervals of Moses, and pairwise testings with Mann-Whitney test. RESULTS The DP test group rated its anxiety significantly lower at follow- up than at baseline (PHAQ < .001). However, at follow-up, anxiety was still higher in DP than in NF (PHAQ = .046; PVAS < .001). Implant success at follow-up was 100%. Oral health was equally good in DP and NF patients. At follow-up, all patients were satisfied with implant therapy, but compliance was better for NF (100%) than for DP (73% dental checkup; 67% dental hygienist). CONCLUSION Implant therapy can be successfully performed in DP patients with PDPT as phobia is not negatively influenced by the invasive implant therapy. However, motivation for professional maintenance programs remains challenging.

Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial

HYPOTHESIS We hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) in a standardized, modified protocol is technically feasible and results in a higher vascularization response and watertight healing rate during early healing. METHODS Twenty patients with chronic rotator cuff tears were randomly assigned to 2 treatment groups. In the test group (N = 10), L-PRF was added in between the tendon and the bone during arthroscopic rotator cuff repair. The second group served as control (N = 10). They received the same arthroscopic treatment without the use of L-PRF. We used a double-row tension band technique. Clinical examinations including subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores and measurement of the vascularization with power Doppler ultrasonography were made at 6 and 12 weeks. RESULTS There have been no postoperative complications. At 6 and 12 weeks, there was no significant difference in the clinical scores between the test and the control groups. The mean vascularization index of the surgical tendon-to-bone insertions was always significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P = .0001). Whereas the L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P = .001), there was no difference after 12 weeks of follow-up (P = .889). Watertight healing was obtained in 89% of the repaired cuffs. DISCUSSION/CONCLUSIONS Arthroscopic rotator cuff repair with the application of L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose to an increased and earlier cellular response and an increased healing rate.

Repetitive transcranial magnetic stimulation: a putative add-on treatment for major depression in elderly patients.

Repetitive transcranial magnetic stimulation (rTMS) is a recent putative treatment for affective disorders. Several studies have demonstrated antidepressant effects of rTMS in younger patients; we aimed to assess its effect in older outpatients with treatment-resistant major depression. Twenty-four outpatients (mean age=62 years, S.D.=12) with major depression were randomized for sham or real stimulation and received 10 daily rTMS sessions (20 Hz, 2-s trains, 28-s intertrain intervals, 100% of motor threshold) in addition to the antidepressant medication. For sham stimulation, the coil was tilted 90 degrees. Depression severity was assessed using the Hamilton Depression Rating Scale, the Beck Depression Inventory, items from the NIMH self-rated symptom scale, and a visual analog depression scale. Mini-Mental Status Examination performance, memory, and executive and attentional functions were measured to control for cognitive side effects. Depression ratings revealed significant antidepressant effects within 2 weeks in both sham and real stimulation groups; however, there were no between-group differences. Treatment with rTMS was safe; adverse events were rare and not more prevalent in either group, and cognitive assessment did not show any deterioration. We were unable to demonstrate any additional antidepressant effects of real stimulation in elderly patients with treatment-resistant major depression. Therapeutic effects of rTMS in this clinically challenging patient group remain to be demonstrated.

Mood effects of repetitive transcranial magnetic stimulation of left prefrontal cortex in healthy volunteers.

This study investigated the effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) of the left prefrontal cortex (LPFC) on mood in a sham-controlled crossover design. Twenty-five healthy male subjects received HF-rTMS of the LPFC in real and sham conditions. Forty trains (frequency 20 Hz, stimulation intensity 100% of individual motor threshold, train duration 2 s, intertrain interval 28 s) were applied in each session. Mood change from baseline was measured with five visual analog scales (VAS) for sadness, anxiety, happiness, tiredness and pain/discomfort. We were unable to demonstrate significant mood changes from baseline on visual analog scales after either sham or real stimulation of LPFC. There is insufficient evidence to support the general conclusion that HF-rTMS of LPFC has mood effects in healthy volunteers. Future studies should be sham-controlled, have larger sample sizes, and strictly stimulate one single region per session in order to exclude interaction effects with the previous stimulation.

Differences in Time to Disease Progression Do Not Predict for Cancer-specific Survival in Patients Receiving Immediate or Deferred Androgen-deprivation Therapy for Prostate Cancer: Final Results of EORTC Randomized Trial 30891 with 12 Years of Follow-up

BACKGROUND Trials assessing the benefit of immediate androgen-deprivation therapy (ADT) for treating prostate cancer (PCa) have often done so based on differences in detectable prostate-specific antigen (PSA) relapse or metastatic disease rates at a specific time after randomization. OBJECTIVE Based on the long-term results of European Organization for Research and Treatment of Cancer (EORTC) trial 30891, we questioned if differences in time to progression predict for survival differences. DESIGN, SETTING, AND PARTICIPANTS EORTC trial 30891 compared immediate ADT (n=492) with orchiectomy or luteinizing hormone-releasing hormone analog with deferred ADT (n=493) initiated upon symptomatic disease progression or life-threatening complications in randomly assigned T0-4 N0-2 M0 PCa patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Time to first objective progression (documented metastases, ureteric obstruction, not PSA rise) and time to objective castration-resistant progressive disease were compared as well as PCa mortality and overall survival. RESULTS AND LIMITATIONS After a median of 12.8 yr, 769 of the 985 patients had died (78%), 269 of PCa (27%). For patients receiving deferred ADT, the overall treatment time was 31% of that for patients on immediate ADT. Deferred ADT was significantly worse than immediate ADT for time to first objective disease progression (p<0.0001; 10-yr progression rates 42% vs 30%). However, time to objective castration-resistant disease after deferred ADT did not differ significantly (p=0.42) from that after immediate ADT. In addition, PCa mortality did not differ significantly, except in patients with aggressive PCa resulting in death within 3-5 yr after diagnosis. Deferred ADT was inferior to immediate ADT in terms of overall survival (hazard ratio: 1.21; 95% confidence interval, 1.05-1.39; p [noninferiority]=0.72, p [difference] = 0.0085). CONCLUSIONS This study shows that if hormonal manipulation is used at different times during the disease course, differences in time to first disease progression cannot predict differences in disease-specific survival. A deferred ADT policy may substantially reduce the time on treatment, but it is not suitable for patients with rapidly progressing disease.

Update as Evidence: Belief Expansion

We introduce a justification logic with a novel constructor for evidence terms, according to which the new information itself serves as evidence for believing it. We provide a sound and complete axiomatization for belief expansion and minimal change and explain how the minimality can be graded according to the strength of reasoning. We also provide an evidential analog of the Ramsey axiom.

Small aliquot and single grain IRSL and post-IR IRSL dating of fluvial and alluvial sediments from the Pativilca valley, Peru

Infrared stimulated luminescence (IRSL) and post-IR IRSL are applied to small aliquots and single grains to determine the equivalent dose (De) of eleven alluvial and fluvial sediment samples collected in the Pativilca valley, Central Peru at ca. 10°S latitude. Small aliquot De distributions are rather symmetric and display over-dispersion values between 15 and 46%. Small aliquot g-values range between 4 and 8% per decade for the IRSL and 1 and 2% per decade for the post-IR IRSL signal. The single grain De distributions are highly over-dispersed with some of them skewed to higher doses, implying partial bleaching; this is especially true for the post-IR IRSL. Measurements of a modern analog reveal that residuals due to partial bleaching are present in both the IRSL as well as the post-IR IRSL signal. The g-values of individual grains exhibit a wide range with high individual uncertainties and might contribute significantly to the spread of the single grain De values, at least for the IRSL data. Electron Microprobe Analysis performed on single grains reveal that a varying K-content can be excluded as the origin of over-dispersion. Final ages for the different approaches are calculated using the Central Age Model and the Minimum Age Model (MAM). The samples are grouped into well-beached, potentially well-bleached and partially bleached according to the evaluation of the single grain distributions and the agreement of age estimates between methods. The application of the MAM to the single grain data resulted in consistent age estimates for both the fading corrected IRSL and the post-IR IRSL ages, and suggests that both approaches are suitable for dating these samples. Keywords

Islam als Problem der Gesellschaft

Die Blicke, die die Wissenschaft auf Islam und Muslime in der Schweiz wirft, sind in den meisten Fällen entweder auf Subjekte gerichtet, oder sie behandeln die soziale und kommunikative Konstruktion jener Phänomene nur mit Blick auf einzelne Teilsysteme der Gesellschaft wie Politik und Massenmedien (respektive öffentliche Diskurse) ohne gesellschaftstheoretische und funktionalistische Rückbindung. Die vorliegende Arbeit positioniert sich in dieser Beobachtungslücke und nimmt die vielfältigen Beobachter der Gesellschaft von Islam und Muslimen in der Schweiz in den Blick. Fragt man danach, welche Strukturen sich wie irritieren lassen, treten die Phänomene Islam und Muslime in den Hintergrund, und auf dem analytischen Schirm erscheint die Gesellschaft selbst. In der Folge werden die umfangreichen Kommunikationsleistungen sichtbar, die eine Irritation in verschiedenen Teilsystemen – nicht nur in der Politik oder den Massenmedien, sondern genauso im Recht, der Religion, der Kunst oder der Wirtschaft – auslöst. Sei es, dass Eltern ihre Kinder aus religiösen Gründen nicht am gemischtgeschlechtlich erteilten Schwimmunterricht an öffentlichen Primarschulen in Basel teilnehmen lassen wollen, oder dass ein muslimischer Verein im Zuge des Um- und Ausbaus ihres Vereinslokals in Langenthal ein Minarett auf dem Dach desselben errichten will: diese und andere Gesuche, (teil-)öffentlich soziale Vielfalt in der Form religiöser Differenz auszudrücken, regen eine Fülle von Beobachtungs- und Kommunikationsleistungen an. Den Hauptteil der vorliegenden Studie bildet denn auch die Analyse der vielfältigen Reaktionen in zwei Konfliktfällen zur Nichtteilnahme am gemischtgeschlechtlich erteilten Schwimmunterricht in Primarschulen Basel-Stadts und dem Baugesuch für ein Minarett und eine Kuppel als Teil des Ausbaus eines Vereinslokals in Langenthal. Die beiden Fälle wurden deshalb ausgewählt, weil ihre anfängliche Irritation quer durch die gesellschaftlichen Teilsysteme hindurch und über mehrere Jahre hinweg Antwortversuche auslöste und die empirische Analyse deshalb über mehr und aussagekräftigeres Material verfügen konnte, als es in anderen, ansonsten für eine Analyse prinzipiell auch denkbaren, Konfliktfällen, beispielsweise zur Einrichtung eines muslimischen Grabfeldes auf einem Friedhof oder dem Tragen eines Kopftuchs an der Schule, bei der Arbeit oder beim Sport, möglich gewesen wäre. Die Beobachtung des Umgangs mit diesen beiden Instanzen sozialer Vielfalt (aber auch in inhaltlich anders gelagerten Fällen der Differenzbearbeitung) macht sichtbar, dass und wie Erwartungen verunsichert und Lösungen für die Aufhebung dieser Unsicherheiten gefunden und ausprobiert werden. Die zentrale Einsicht der Studie lautet, dass selbstreproduzierende und selbstorganisierende Systeme, wie es Recht, Politik, Massenmedien, Kunst und Religion unter den Bedingungen einer funktional differenzierten, modernen Gesellschaft sind, aufgrund ihrer spezifischen Funktionsweise in der Gesellschaft ihre eigenen Zugänge zu religiöser Vielfalt entwickeln, die sich nur schwer miteinander vereinbaren lassen. In anderen Worten interessiert sich das Rechtssystem für die rechtlichen Folgen des Auftauchens islamischer Normativitäten, die Politik für daraus resultierende Machtansprüche, oder die Massenmedien für das aus der Vielfalt resultierende Konfliktpotenzial. Um gleichzeitig diese Einsicht in kürzeste Form zu bringen und die Wahl des Titels der vorliegenden Studie zu erläutern, sind Islam und Muslime kommunikativ konstruierte Artefakte. Sie werden jeweils dazu, was die Gesellschaft – respektive die sozialen Systeme, aus denen diese besteht – aus ihnen vermittels ihrer eigenen Beobachtungsleistungen macht. Dies schliesst natürlich die im vorliegenden Text kommunizierten Beschreibungen mit ein, da auch sie nichts anderes als einen Vollzug von Gesellschaft darstellen. Die Analyse von Konfliktfällen zu muslimisch-religiöser Diversität in den folgenden Kapiteln will dementsprechend keine Aussagen über Islam, Muslime und ihre Hintergründe und Motivlagen, die zu Konflikten führen könnten, treffen. Jenseits dieser subjektorientierten Beschreibungen genügt es dem Anspruch der vorliegenden Arbeit jedoch auch nicht, nur das Kursieren von Differenzsemantiken oder Diskursen über Islam und Muslime festzustellen – obwohl dies einen Teil der Analyse bildet. Diese gesellschaftlichen Problematisierungen von und die mannigfaltigen „Umgangsformen“ gegenüber Islam und Muslimen, oder allgemeiner: gegenüber Fremdheit, Differenz, Vielfalt – sollen zudem auf ihre funktionalen und gesellschaftsstrukturellen Ermöglichungsbedingungen und Grenzen hin untersucht werden. Wenn die vorliegende Studie Konfliktfälle analysiert, die als muslimisch bezeichnete Personen in die Kommunikation miteinbeziehen, liegt ihr Forschungsinteresse also auf einer Beobachtungsebene zweiter Ordnung und in den Formen des kommunikativen Umgangs mit Kontingenz und Vielfalt in der Form von „Islam“ und „Muslimen“ – und dafür, wo die Grenzen dieses Umgangs liegen. Dementsprechend sind die beiden fallanalytischen Kapitel (4 und 5) nach systemspezifischen Problemlösungen des Rechts, der Politik, der Massenmedien, der Kunst und der Religion strukturiert. Der Einsatz eines systemtheoretischen Analyserahmens, wie in Kapitel 2 dargestellt, in Kombination mit einer adaptierten Methode (in Kapitel 3 diskutiert) ermöglicht es dabei,spezifische, system- oder beobachterspezifische Unterscheidungsleistungen zu erkennen, die den jeweiligen Problemlösungsstrategien zu Grunde liegen. Die Bezeichnung „systemtheoretisch“ deutet dabei bereits an, dass sich der Analysefokus von individuellen Akteuren mit Motiven und Handlungen weg und in Richtung überindividueller, also sozialer, Kommunikationsstrukturen verschiebt. Die erkenntnistheoretischen Grundlagen der alltäglichen und wissenschaftlichen Beschäftigung mit dem, was gemeinhin „Realität“ genannt wird, werden gleich in Kapitel 2 diskutiert, um die Basis für die darauffolgenden konstruktivistischen, kommunikations-, system- und differenztheoretischen sowie funktionalistischen Überlegungen der hier verwendeten Methodologie zu schaffen (Kapitel 3). Der empirischen Erforschung der kommunikativen Mechanismen des Umgangs mit (sozialer Vielfalt, hier: Islamität zugeschriebener) Kontingenz widmet sich die vorliegende Arbeit daraufhin anhand der beiden obengenannten Fallstudien des Schwimmunterrichts in Basel-Stadt (Kapitel 4) und des Minarettbaugesuchs in Langenthal (Kapitel 5). Eine Analyse der kommunikativen Unterscheidungsleistungen, die Objekte durch sprachlichen Ein- und Ausschluss (und blinde Flecken) konstruiert, fördert die Schlüsselstellung von System- und Gesellschaftsstrukturen, tradierten Gesellschaftsbildern, Integrationsvorstellungen und dem ungebrochenen Vertrauen in die Möglichkeit gesellschaftlicher Steuerung für die Grenzen des Umgangs mit sozialer Vielfalt zu Tage. In der Fallstudie zum Schwimmunterricht in Basel (Kapitel 4) treten einander die Beobachtungsperspektiven des Rechts, der Politik, der Erziehung und der Massenmedien gegenüber, und ihre verschiedenen Funktionslogiken werden sichtbar. Angesichts dieses Befunds gesellschaftlicher Ausdifferenzierung zeichnet sich die Schwierigkeit ab, noch vom Nichtbesuch des Schwimmunterrichts aus religiösen Gründen als einem Problem zu sprechen. Im Gegenteil: in der funktional differenzierten, modernen Gesellschaft stellt der Widerspruch, das „Nein“ der Absage an den Besuch des gemischtgeschlechtlich erteilten Schwimmunterrichts, ein Mehrfachproblem dar. Er wird von mehreren Systemen gleichzeitig, aber aufgrund ihrer Funktion und Strukturen unterschiedlich beobachtet. Darüber hinaus lassen sich auch innerhalb politischer Kommunikation von Seiten der Integrations-, Erziehungs- und Ausländerpolitik drei unterschiedliche „Lösungsansätze“ feststellen. Das Kapitel beschreibt diese funktionale Differenzierung für das Rechtssystem, die Politik und die Massenmedien anhand empirischer Daten wie Gerichtsurteilen, Verwaltungsakten und -publikationen, politischen Vorstössen, massenmedialen Produkten und Interviews. Der Aufbau des Kapitels orientiert sich an jenen systemischen Zugängen. Der Befund der funktionalen Differenzierung wird in einem zweiten Schritt den Selbstbeschreibungen der Systeme gegenüber gestellt, um in den jeweiligen Erwartungsstrukturen die semantischen Grenzen des Umgangs mit Fremdheit respektive Vielfalt aufzudecken und den Weg für Alternativen zu ebnen. Die Fallanalyse zum Minarettbaugesuch in Langenthal (Kapitel 5) ermöglicht eine Überprüfung der Ergebnisse aus der Analyse zum Schwimmunterricht. Im Fall Langenthal bestätigt sich der Befund der systemisch differenzierten Zugänge zum Konfliktfall, wobei zusätzlich zum Recht, der Politik und den Massenmedien in diesem Fall auch die Systeme Religion und Kunst kommunikativ beteiligt sind. Auch dieses Kapitel ist analog zur Fallanalyse dees Schwimmunterrichts entlang der systemischen Zugänge aufgebaut. Durch die Vergleichsmöglichkeiten mit dem Fall Basel können im Fall Langenthal empirische Befunde zu den Formen und Grenzen gesellschaftlicher Selbstbeschreibungen und dem Umgang mit sozialer Vielfalt noch vertieft werden, und um die religiöse und künstlerische Dimension erweitert werden. Das Schlusskapitel (Kapitel 6) rollt die Befunde zur zentralen Bedeutung von Gesellschaftsstruktur und -bildern, Integrations- und Steuerungskonzepten für den Umgang mit islamischer und anderen Formen sozialer Vielfalt – und seine Beschränkungen – noch einmal auf. In der Folge setzt es sich auf der Grundlage der bisher erarbeiteten Erkenntnisse mit einem alternativen Ansatz des Umgangs mit Differenz, der Selbstreflektion, auseinander. Und schliesslich werden die Implikationen dieser Art von Analysen für die Islamwissenschaft sowie wissenschaftliche Anschlussmöglichkeiten diskutiert.

Ultracold Quantum Gases and Lattice Systems: Quantum Simulation of Lattice Gauge Theories

Abelian and non-Abelian gauge theories are of central importance in many areas of physics. In condensed matter physics, AbelianU(1) lattice gauge theories arise in the description of certain quantum spin liquids. In quantum information theory, Kitaev’s toric code is a Z(2) lattice gauge theory. In particle physics, Quantum Chromodynamics (QCD), the non-Abelian SU(3) gauge theory of the strong interactions between quarks and gluons, is nonperturbatively regularized on a lattice. Quantum link models extend the concept of lattice gauge theories beyond the Wilson formulation, and are well suited for both digital and analog quantum simulation using ultracold atomic gases in optical lattices. Since quantum simulators do not suffer from the notorious sign problem, they open the door to studies of the real-time evolution of strongly coupled quantum systems, which are impossible with classical simulation methods. A plethora of interesting lattice gauge theories suggests itself for quantum simulation, which should allow us to address very challenging problems, ranging from confinement and deconfinement, or chiral symmetry breaking and its restoration at finite baryon density, to color superconductivity and the real-time evolution of heavy-ion collisions, first in simpler model gauge theories and ultimately in QCD.

Future prospects for SPECT imaging using the radiolanthanide terbium-155 — production and preclinical evaluation in tumor-bearing mice

We assessed the suitability of the radiolanthanide 155 Tb (t1/2 = 5.32 days, Eγ = 87 keV (32%), 105 keV (25%)) in combination with variable tumor targeted biomolecules using preclinical SPECT imaging. Methods 155Tb was produced at ISOLDE (CERN, Geneva, Switzerland) by high-energy (~ 1.4 GeV) proton irradiation of a tantalum target followed by ionization and on-line mass separation. 155 Tb was separated from isobar and pseudo-isobar impurities by cation exchange chromatography. Four tumor targeting molecules – a somatostatin analog (DOTATATE), a minigastrin analog (MD), a folate derivative (cm09) and an anti-L1-CAM antibody (chCE7) – were radiolabeled with 155 Tb. Imaging studies were performed in nude mice bearing AR42J, cholecystokinin-2 receptor expressing A431, KB, IGROV-1 and SKOV-3ip tumor xenografts using a dedicated small-animal SPECT/CT scanner. Results The total yield of the two-step separation process of 155 Tb was 86%. 155 Tb was obtained in a physiological l-lactate solution suitable for direct labeling processes. The 155 Tb-labeled tumor targeted biomolecules were obtained at a reasonable specific activity and high purity (> 95%). 155 Tb gave high quality, high resolution tomographic images. SPECT/CT experiments allowed excellent visualization of AR42J and CCK-2 receptor-expressing A431 tumors xenografts in mice after injection of 155 Tb-DOTATATE and 155 Tb-MD, respectively. The relatively long physical half-life of 155 Tb matched in particular the biological half-lives of 155 Tb-cm09 and 155 Tb-DTPA-chCE7 allowing SPECT imaging of KB tumors, IGROV-1 and SKOV-3ip tumors even several days after administration. Conclusions The radiolanthanide 155 Tb may be of particular interest for low-dose SPECT prior to therapy with a therapeutic match such as the β--emitting radiolanthanides 177Lu, 161 Tb, 166Ho, and the pseudo-radiolanthanide 90Y.

Real-life results of balloon kyphoplasty for vertebral compression fractures from the SWISSspine registry

BACKGROUND CONTEXT The Swiss Federal Office of Public Health mandated a nationwide health technology assessment-registry for balloon kyphoplasty (BKP) for decision making on reimbursement of these interventions. The early results of the registry led to a permanent coverage of BKP by basic health insurance. The documentation was continued for further evidence generation. PURPOSE This analysis reports on the 1 year results of patients after BKP treatment. STUDY DESIGN Prospective multicenter observational case series. PATIENT SAMPLE The data on 625 cases with 819 treated vertebrae were documented from March 2005 to May 2012. OUTCOME MEASURES Surgeon-administered outcome instruments were primary intervention form for BKP and the follow-up form; patient self-reported measures were EuroQol-5D questionnaire, North American Spine Society outcome instrument /Core Outcome Measures Index (including visual analog scale), and a comorbidity questionnaire. Outcome measures were back pain, medication, quality of life (QoL), cement extrusions, and new fractures within the first postoperative year. METHODS Data were recorded preoperatively and at 3 to 6-month and 1-year follow-ups. Wilcoxon signed-rank test was used for comparison of pre- with postoperative measurements. Multivariate logistic regression was used to identify factors with a significant influence on the outcome. RESULTS Seventy percent of patients were women with mean age of 71 years (range, 18-91 years); mean age of men was 65 years (range, 15-93 years). Significant and clinically relevant reduction of back pain, improvement of QoL, and reduction of pain killer consumption was seen within the first postoperative year. Preoperative back pain decreased from 69.3 to 29.0 at 3 to 6-month and remained unchanged at 1-year follow-ups. Consequently, QoL improved from 0.23 to 0.71 and 0.75 at the same follow-up intervals. The overall vertebra-based cement extrusion rates with and without extrusions into intervertebral discs were 22.1% and 15.3%, respectively. Symptomatic cement extrusions with radiculopathy were five (0.8%). A new vertebral fracture within a year from the BKP surgery was observed in 18.4% of the patients. CONCLUSIONS The results of the largest observational study for BKP so far are consistent with published randomized trials and systematic reviews. In this routine health care setting, BKP is safe and effective in reducing pain, improving QoL, and lowering pain_killer consumption and has an acceptable rate of cement extrusions. Postoperative outcome results show clear and significant clinical improvement at early follow-up that remain stable during the first postoperative year.

Sexual function after vaginal and abdominal fistula repair

OBJECTIVE The purpose of this study was to compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF). STUDY DESIGN Participants (99 women with VVF at a tertiary referral center) were treated with urinary catheterization for 12 weeks and, if the procedure was unsuccessful, underwent repair either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed; subjective outcomes were recorded prospectively at the 6-month follow-up examination with the use of the female sexual function index to evaluate sexual function and the visual analogue scale to measure general disturbance by the fistula. RESULTS After bladder drainage for 12 weeks, 8 patients had spontaneous fistula closure. Demographic variables were similar in the transvaginal (n = 60) and transabdominal (n = 31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss, and shorter hospital stay. Continence rates 6 months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved, and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding any domain of sexual function or visual analog scale. CONCLUSION Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable.