Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management.

Myofascial pain associated to trigger points: A literature review. Part 2: Differential diagnosis and treatment

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.

Significance of an isolated new right bundle branch block in a patient with chest pain.

Chest pain is a common presenting symptom in emergency departments, and a typical manifestation of acute myocardial infarction (AMI). Recognition of ECG changes in AMI is essential for timely diagnosis and treatment. Right bundle branch block (RBBB) may be an isolated sign of AMI, and was previously considered as a criterion for fibrinolytic therapy. Since the most recent European Society of Cardiology and American Heart Association guidelines in 2013, RBBB alone is no longer considered a diagnostic criterion of AMI, even if it occurs in the context of acute chest pain, as RBBB does not usually interfere with the interpretation of ST-segment alteration. Our case illustrates an acute septal myocardial infarction with an isolated RBBB, and thus the importance of recognising this pattern in order to permit timely diagnosis and treatment.

Posterior Sub-Tenon Triamcinolone Injection for Chronic Macular Oedema Associated With Non-Ischemic Branch or Central Retinal Vein Occlusion

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized eye. Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and 12 (if required) months after injections and re-injection considered. Results: In the BRVO group, mean foveal thickness was 548.2±49.50 μm preoperatively, and 452.8±56.2 μm and 280.8±62.5 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test) 3 months after injections. Improvement of visual acuity by at least 0.2 LogMAR was seen in 3(50%) of the 6 eyes. No re-injection was needed. In the CRVO group, mean foveal thickness was 543.7±34.4 μm preoperatively, and 283.0±29.0 μm and 234.8±23.6 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test). Improvement of visual acuity by at least 0.2 LogMAR was seen in 7 eyes (88%). Mean number of re-injection was of 2.1±0.3. Intraocular pressure elevation of 22 mm Hg or higher was found in 2/14 eyes (14%). Cataract progression was noted in 5/14 eyes (36%). Conclusions: PST injection of TA appears to be as safe and effective treatment for chronic macular oedema associated due to both non-ischemic BRVO or CRVO, with a better efficacy in BRVO.

A Preclinical Model for ERα-Positive Breast Cancer Points to the Epithelial Microenvironment as Determinant of Luminal Phenotype and Hormone Response.

Seventy-five percent of breast cancers are estrogen receptor α positive (ER(+)). Research on these tumors is hampered by lack of adequate in vivo models; cell line xenografts require non-physiological hormone supplements, and patient-derived xenografts (PDXs) are hard to establish. We show that the traditional grafting of ER(+) tumor cells into mammary fat pads induces TGFβ/SLUG signaling and basal differentiation when they require low SLUG levels to grow in vivo. Grafting into the milk ducts suppresses SLUG; ER(+) tumor cells develop, like their clinical counterparts, in the presence of physiological hormone levels. Intraductal ER(+) PDXs are retransplantable, predictive, and appear genomically stable. The model provides opportunities for translational research and the study of physiologically relevant hormone action in breast carcinogenesis.

Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging

Abstract Objective: To assess the prevalence of isolated findings of abnormalities leading to entrapment of the lateral plantar nerve and respective branches in patients complaining of chronic heel pain, whose magnetic resonance imaging exams have showed complete selective fatty atrophy of the abductor digiti quinti muscle. Materials and Methods: Retrospective, analytical, and cross-sectional study. The authors selected magnetic resonance imaging of hindfoot of 90 patients with grade IV abductor digiti quinti muscle atrophy according to Goutallier and Bernageau classification. Patients presenting with minor degrees of fatty muscle degeneration (below grade IV) and those who had been operated on for nerve decompression were excluded. Results: A female prevalence (78.8%) was observed, and a strong correlation was found between fatty muscle atrophy and plantar fasciitis in 21.2%, and ankle varices, in 16.8% of the patients. Conclusion: Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle.

Change points detection in crime-related time series: an on-line fuzzy approach based on a shape space representation

The extension of traditional data mining methods to time series has been effectively applied to a wide range of domains such as finance, econometrics, biology, security, and medicine. Many existing mining methods deal with the task of change points detection, but very few provide a flexible approach. Querying specific change points with linguistic variables is particularly useful in crime analysis, where intuitive, understandable, and appropriate detection of changes can significantly improve the allocation of resources for timely and concise operations. In this paper, we propose an on-line method for detecting and querying change points in crime-related time series with the use of a meaningful representation and a fuzzy inference system. Change points detection is based on a shape space representation, and linguistic terms describing geometric properties of the change points are used to express queries, offering the advantage of intuitiveness and flexibility. An empirical evaluation is first conducted on a crime data set to confirm the validity of the proposed method and then on a financial data set to test its general applicability. A comparison to a similar change-point detection algorithm and a sensitivity analysis are also conducted. Results show that the method is able to accurately detect change points at very low computational costs. More broadly, the detection of specific change points within time series of virtually any domain is made more intuitive and more understandable, even for experts not related to data mining.

Fuzzy subgroups, algebraic and topological points of view and complex analysis

Fuzzy subsets and fuzzy subgroups are basic concepts in fuzzy mathematics. We shall concentrate on fuzzy subgroups dealing with some of their algebraic, topological and complex analytical properties. Explorations are theoretical belonging to pure mathematics. One of our ideas is to show how widely fuzzy subgroups can be used in mathematics, which brings out the wealth of this concept. In complex analysis we focus on Möbius transformations, combining them with fuzzy subgroups in the algebraic and topological sense. We also survey MV spaces with or without a link to fuzzy subgroups. Spectral space is known in MV algebra. We are interested in its topological properties in MV-semilinear space. Later on, we shall study MV algebras in connection with Riemann surfaces. In fact, the Riemann surface as a concept belongs to complex analysis. On the other hand, Möbius transformations form a part of the theory of Riemann surfaces. In general, this work gives a good understanding how it is possible to fit together different fields of mathematics.

Identification of Turning Points in the Research on Titanium Dioxide Production and Application

This dissertation "Identification of turning points in the research on titanium dioxide production and application" aims at detecting in scientific literatures emerging trends and sudden changes in titanium dioxide production and application. These key changes are then studied to determine its transient patterns and its effect on the research on titanium dioxide production and application The source of information is from bibliographic data which discussed titanium dioxide production and application. These bibliographic data where obtained from ISI Web of Knowledge and then formed into a network of clusters by applying software called Citespace.

Stellar population synthesis: the effect of improved Asymptotic Giant Branch models and of interstellar dust on mass-to-light–color relations

Teoreettisen populaatiosynteesin avulla voidaan mallintaa tähtijoukkojen ja galaksien fotometrisiä ominaisuuksia yhdistämällä yksittäisten tähtien tuottama säteily, joka saadaan teoreettisista tähtien kehitysmalleista. Valitsemalla sopiva massajakauma syntyville tähdille voidaan muodostaa yksinkertainen tähtipopulaatio, joka koostuu saman ikäisistä ja kemialliselta koostumukseltaan yhtenäisistä tähdistä. Monimutkaisempia tähtipopulaatioita voidaan muodostaa konvoloimalla yksinkertaisten tähtipopulaatioiden luminositeetti jonkin valitun tähtienmuodostushistorian kanssa sekä yhdistämällä näin muodostettuja populaatioita. Tässä työssä tarkastellaan asymptoottisen jättiläishaaran (AGB) tähtien uusien, tarkentuneiden evoluutiomallien vaikutusta populaatiosynteesin tuloksiin niin yksinkertaisten tähtipopulaatioiden kuin galaksien mallinnukseen soveltuvien monimutkaisempien tähtipopulaatioiden kohdalla. Työn päätarkoitus on tuottaa uudistuneisiin malleihin perustuvat populaation massa-luminositeetti -suhteen ja värin väliset relaatiot (MLC-relaatiot). MLC-relaatioita voidaan käyttää populaation massan määrittämiseen sen fotometristen ominaisuuksien (väri, luminositeetti) perusteella. Lisäksi tutkitaan tähtienvälisen pölyn vaikutusta yksinkertaisen spiraaligalaksimallin MLC-relaatioihin. Työssä käytetyt tähtien kehitysmallit perustuvat julkaisuun Marigo et al. (Astronomy & Astrophysics 482, 2008). Havaitaan, että AGB-tähtien vaikutus populaation integroituun luminositeettiin on pieni näkyvillä aallonpituuksilla, mutta merkittävä lähi-infrapuna-alueella. Vaikutus MLC-relaatioihin on vastaavasti merkittävä tarkkailtaessa luminositeettia lähi-infrapunassa sekä käytettäessä värejä, joissa yhdistetään optisia ja lähi-infrapunan kaistoja. Todetaan, että MLC-relaatioiden käyttö lähi-infrapunassa edellyttää tarkentuneen AGB-vaiheen sisällyttämistä populaatiosynteesin malleihin. Tähtienvälisen pölyn vaikutus MLC-relaatioihin todetaan riippuvan käytetystä kaistasta ja väristä, mutta vaikutuksen havaitaan olevan suurin optisen ja lähi-infrapunan väriyhdistelmillä.

Nietzsche and Neo-Kantian historiography: points of contact

In the German academies of Nietzsche's period of writing, the Kantian tradition was largely displaced in favor of two independent schools that have since been labeled "Neo-Kantianism." This paper presents four key theses about philosophy of history from four Neo-Kantian thinkers, how they follow from their adaptation of the Kantian tradition, and how Nietzsche critically engaged the very same issues in the formation of his own historical theory. Although there is little direct influence between orthodox Neo-Kantianism and Nietzsche, their comparison on these points will illuminate their unique adaptations of the Kantian tradition.