Foods, nutrients and the risk of oral and pharyngeal cancer.

Background:Besides tobacco and alcohol, dietary habits may have a relevant role in oral cavity and pharyngeal (OCP) cancer.Methods:We analysed the role of selected food groups and nutrients on OCP cancer in a case-control study carried out between 1997 and 2009 in Italy and Switzerland. This included 768 incident, histologically confirmed squamous cell carcinoma cases and 2078 hospital controls. Odds ratios (ORs) were estimated using logistic regression models including terms for tobacco, alcohol and other relevant covariates.Results:Significant inverse trends in risk were observed for all vegetables (OR=0.19, for the highest vs the lowest consumption) and all fruits (OR=0.39), whereas significant direct associations were found for milk and dairy products (OR=1.50), eggs (OR=1.71), red meat (OR=1.55), potatoes (OR=1.85) and desserts (OR=1.68), although trends in risk were significant only for potatoes and desserts. With reference to nutrients, significant inverse relations were observed for vegetable protein (OR=0.45, for the highest vs the lowest quintile), vegetable fat (OR=0.54), polyunsaturated fatty acids (OR=0.53), α-carotene (OR=0.51), β-carotene (OR=0.28), β-cryptoxanthin (OR=0.37), lutein and zeazanthin (OR=0.34), vitamin E (OR=0.26), vitamin C (OR=0.40) and total folate (OR=0.34), whereas direct ones were observed for animal protein (OR=1.57), animal fat (OR=2.47), saturated fatty acids (OR=2.18), cholesterol (OR=2.29) and retinol (OR=1.88). Combinations of low consumption of fruits and vegetables, and high consumption of meat with high tobacco and alcohol, led to 10- to over 20-fold excess risk of OCP cancer.Conclusion:Our study confirms and further quantifies that a diet rich in fruits and vegetables and poor in meat and products of animal origin has a favourable role against OCP cancer.

On-line desorption of dried blood spot: A novel approach for the direct LC/MS analysis of micro-whole blood samples.

The aim of this work is to present a new concept, called on-line desorption of dried blood spots (on-line DBS), allowing the direct analysis of a dried blood spot coupled to liquid chromatography mass spectrometry device (LC/MS). The system is based on an inox cell which can receive a blood sample (10 microL) previously spotted on a filter paper. The cell is then integrated into LC/MS system where the analytes are desorbed out of the paper towards a column switching system ensuring the purification and separation of the compounds before their detection on a single quadrupole MS coupled to atmospheric pressure chemical ionisation (APCI) source. The described procedure implies that no pretreatment is necessary in spite the analysis is based on whole blood sample. To ensure the applicability of the concept, saquinavir, imipramine, and verapamil were chosen. Despite the use of a small sampling volume and a single quadrupole detector, on-line DBS allowed the analyses of these three compounds over their therapeutic concentrations from 50 to 500 ng/mL for imipramine and verapamil and from 100 to 1000 ng/mL for saquinavir. Moreover, the method showed good repeatability with relative standard deviation (RSD) lower than 15% based on two levels of concentration (low and high). Function responses were found to be linear over the therapeutic concentration for each compound and were used to determine the concentrations of real patient samples for saquinavir. Comparison of the founded values with those of a validated method used routinely in a reference laboratory showed a good correlation between the two methods. Moreover, good selectivity was observed ensuring that no endogenous or chemical components interfered with the quantitation of the analytes. This work demonstrates the feasibility and applicability of the on-line DBS procedure for bioanalysis.

Effects of antiresorptive agents on bone micro-architecture assessed by Trabecular Bone Score in women age 50 and older. The Manitoba Prospective Study

Antiresorptive agents such as bisphosphonates induce a rapid increase of BMD during the 1st year of treatment and a partial maintenance of bone architecture. Trabecular Bone Score (TBS), a new grey-level texture measurement that can be extracted from the DXA image, correlates with 3D parameters of bone micro-architecture. Aim: To evaluate the longitudinal effect of antiresorptive agents on spine BMD and on site-matched spine microarchitecture as assessed by TBS. Methods: From the BMD database for Province of Manitoba, Canada, we selected women age >50 with paired baseline and follow up spine DXA examinations who had not received any prior HRT or other antiresorptive drug.Women were divided in two subgroups: (1) those not receiving any HRT or antiresorptive drug during follow up (=non-users) and (2) those receiving non-HRT antiresorptive drug during follow up (=users) with high adherence (medication possession ratio >75%) from a provincial pharmacy database system. Lumbar spine TBS was derived by the Bone Disease Unit, University of Lausanne, for each spine DXA examination using anonymized files (blinded from clinical parameters and outcomes). Effects of antiresorptive treatment for users and non-users on TBS and BMD at baseline and during mean 3.7 years follow-up were compared. Results were expressed % change per year. Results: 1150 non-users and 534 users met the inclusion criteria. At baseline, users and non-users had a mean age and BMI of [62.2±7.9 vs 66.1±8.0 years] and [26.3±4.7 vs 24.7±4.0 kg/m²] respectively. Antiresorptive drugs received by users were bisphosphonates (86%), raloxifene (10%) and calcitonin (4%). Significant differences in BMD change and TBS change were seen between users and nonusers during follow-up (p<0.0001). Significant decreases in mean BMD and TBS (−0.36± 0.05% per year; −0.31±0.06% per year) were seen for non-users compared with baseline (p<0.001). A significant increase in mean BMD was seen for users compared with baseline (+1.86±0.0% per year, p<0.0018). TBS of users also increased compared with baseline (+0.20±0.08% per year, p<0.001), but more slowly than BMD. Conclusion: We observed a significant increase in spine BMD and a positive maintenance of bone micro-architecture from TBS with antiresorptive treatment, whereas the treatment naïve group lost both density and micro-architecture. TBS seems to be responsive to treatment and could be suitable for monitoring micro-architecture. This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: M.-A. Krieg: None declared, A. Goertzen: None declared, W. Leslie: None declared, D. Hans Consulting fees from Medimaps.

The use of micro-XRD for the study of glaze color decorations

The compounds responsible for the colours and decorations in glass and glazed ceramics include: colouring agents (transition metal ions), pigments (micro-and nano-precipitates of compounds that either do not dissolve or recrystallize in the glassy matrix) and opacifiers (microcrystalline compounds with high light scattering capability). Their composition, structure and range of stability are highly dependent not only on the composition but also on the procedures followed to obtain them. Chemical composition of the colorants and crystallites may be obtained by means of SEM-EDX and WDX. Synchrotron Radiation micro-X-ray Diffraction has a small beam size adequate (10 to 50 microns footprint size) to obtain the structural information of crystalline compounds and high brilliance, optimal for determining the crystallites even when present in low amounts. In addition, in glass decorations the crystallites often appear forming thin layers (from 10 to 100 micrometers thick) and they show a depth dependent composition and crystal structure. Their nature and distribution across the glass/glazes decorations gives direct information on the technology of production and stability and may be related to the color and appearance. A selection of glass and glaze coloring agents and decorations are studied by means of SR-micro- XRD and SEM-EDX including: manganese brown, antimony yellow, red copper lusters and cobalt blue. The selection includes Medieval (Islamic, and Hispano Moresque) and renaissance tin glazed ceramics from the 10th to the 17th century AD.

Optimització dels paràmetres de procés de l’electroerosió de micro-canals en acer inoxidable per aplicacions biomèdiques

El present projecte està enfocat en la mecanització de micro-canals, on la fabricació anivell micro s’entén per a mecanitzacions de menys de 1 mil•límetre, mitjançantl’electroerosió i s’emmarca dins el grup de recerca en enginyeria del producte procés iproducció (GREP) de la universitat de Girona. Avui en dia la biomedicina és un sectorque està creixent i representa una gran oportunitat per a aquest tipus de mecanitzat, jaque alguns productes són de mida micromètrica i es necessita una alternativa almecanitzat tradicional per tal d’abaratir costos, guanyar precisió i qualitat superficial.La mecanització de micro-canals, geometria utilitzada en aquest sector, de granprecisió i elevat acabat superficial són requisits necessaris per donar respostes a lesnecessitats d’aquest camp. L’acer inoxidable 316L és un material molt utilitzat enbiomedicina gràcies a la seva biocompatibilitat. Exemples de la seva aplicació podenser els implants, les pròtesis, utensilis mèdics, etc

Si3N4 single-crystal nanowires grown from silicon micro- and nanoparticles near the threshold of passive oxidation

A simple and most promising oxide-assisted catalyst-free method is used to prepare silicon nitride nanowires that give rise to high yield in a short time. After a brief analysis of the state of the art, we reveal the crucial role played by the oxygen partial pressure: when oxygen partial pressure is slightly below the threshold of passive oxidation, a high yield inhibiting the formation of any silica layer covering the nanowires occurs and thanks to the synthesis temperature one can control nanowire dimensions

Efecte sobre la capacitat d'intercanvi catiònic del sòl i la retenció de nutrients de les aplicacions de biochar en sòls agrícoles

El biochar, o biocarbó, és un material produït a partir de la piròlisi de biomassa, consistent en la descomposició tèrmica de la matèria orgànica a baixa o nul·la concentració d’oxigen. La seva definició més acceptada és la d’un material pirolitzat destinat a ser utilitzat en el sòl, quedant fora d’aquesta denominació materials produïts per a ser utilitzats com a combustible. La gran varietat de materials pirolitzables i de tecnologies de piròlisi determinen un ampli ventall de biochars amb propietats físiques, químiques i biològiques molt contrastades, i que determinen la seva idoneïtat o no per a ser utilitzat com a esmena orgànica, sent la biomassa de partida un dels factors més determinants. Els processos de piròlisis generen gasos inflamables, gasos condensables inflamables (bioolis) i biochar en proporcions variables segons el tipus de piròlisi. Aquests grans tipus principals de piròlisi per la producció de biochar són: Piròlisi lenta, Piròlisi ràpida, i Gasificació. El producte biochar, totalment en procés d’investigació, es creu que pot tenir grans beneficis ambientals en diferents àmbits: Biochar com a millora de la fertilitat, Biochar com a via de gestió de residus, Biochar per producció d’energia, i Biochar per la mitigació del canvi climàtic. Cal tenir en compte possibles riscos a l’hora d’aplicar biochar en sòls. Ja que el producte final varia segons el material de partida. En especial quan es genera biochar a partir de residus, ja siguin de depuradora, industrials o ramaders, degut que el seu contingut en contaminants pot ser perjudicial pel medi ambient i per la salut de les plantes. Els contaminats presents, sobretot metalls pesats i hidrocarburs aromàtics policíclics (PAH), són difícilment eliminats o es produeixen “de novo” durant el procés de piròlisi, respectivament, de manera que amb les aplicacions de biochar poden causar impactes negatius. En aquest projecte, es centre especial atenció en una única característica del sòl, com es la capacitat d’intercanvi catiònic (CIC). La CIC és la capacitat que té el sòl per retenir i alliberar ions amb càrrega positiva. Per les seves característiques, l’argila i la matèria orgànica són les que condicionen la CIC total d’un sòl, ja que aquestes contenen carregues negatives a la seva superfície. La CIC proporciona als sòls la capacitat de retenir nutrients, necessaris per el creixement de les plantes, per tant una major CIC incrementa la fertilitat dels sòls, així com permet reduir les pèrdues d’aquests nutrients per lixiviació i mitigar possible contaminació de les aigües. L’objectiu principal del projecte doncs, és estudiar el potencial ús d’un biochar de gasificació com esmena orgànica per a sòls agrícoles alcalins mediterranis, i més concretament el seu paper per a millora de la retenció de nutrients en relació al potencial augment de la capacitat d’intercanvi catiònic (CIC) del sòl 18 mesos després de la seva aplicació en parcel·les de camp. Les conclusions finals no han estat del tot satisfactòries, degut que no s’han trobat diferències en la CIC, havent de rebutjar la hipòtesi de partida. Tot i que hi ha diferents factors que poden ser la causa d’aquests resultats. Una possibilitat, probablement la que dona major explicació, és el poc temps transcorregut des de l’aplicació de biochar fins al moment de les anàlisis.

Origin of needle fibre calcite (NFC) : a geochemical approach

ABSTRACTNeedle fibre calcite (NFC) is one of the most widespread habits of pedogenic calcite. It is a monocrystal of calcite, in the shape of a needle, with a diameter of one micron and a length between 4 and 103 times its width. NFC occurs in soils with different macroscopic and microscopic morphologies. Macroscopically, two main habits of NFC exist: "cotton ball'Mike clusters and as "powder" coating on pebbles inside the soil. It can also act as nucleation sites for precipitation of calcite cements of purely physicochemical origin (LCC - Late Calcitic Cement). Although many studies have been conducted on needle fibre calcite, its origin remains a subject of debate. The NFC having never been reproduced in the laboratory whatever the considered approach, the processes responsible for its precipitation as a so particular morphology remain unexplained. The shift between the length orientation of the needle crystal and the normal axis of calcite growth (c-axis) is also unresolved.Samples taken in two soils observed in quarries (Villiers and Savagnier) in the Swiss Jura Mountains are used to investigate the processes involved in the formation of these calcite crystals in pedogenic environments. Three groups of microscopic morphologies are distinguished: (i) simple needles (SN), (ii) simple needles with overgrowths (SNO), and (iii) simple needles with nanofibres (SNN), nanofibres being either organic or mineral in nature. These groups correspond to different stages in the formation and evolution of NFC.Comparison of carbon and oxygen isotope compositions of NFC with LCC, in relationship with the composition of the carbonate host rock (CHR), and the carbon isotope signature of dissolved inorganic carbon (DIC) from the soil waters, indicates that both NFC and LCC are precipitated in isotopic equilibrium with the soil solution. Similar Ô13C and Ô180 values of the elongated NFC and the rhombohedral calcite crystals of the LCC suggest that the precipitation of these different calcite habits is not due to changes in physicochemical conditions. The growth of NFC crystals inside an organic mould formed by the fungal hyphae could explain the formation of calcite ciystals in the shape of a needle in isotopic equilibrium with the local environment.Strontium and calcium isotope compositions of the three microscopic groups of NFC and LCC were also studied, in order to determine the origin of calcium (Ca2+) entrapped in the calcite lattice and to elucidate the processes responsible for the precipitation of NFC. The 87Sr/86Sr ratio of the SN is closer to the 87Sr/86Sr ratio of the carbonate host rock than the LCC, SNO, and SNN. This could be another clue for the formation of SN inside fungal hyphae, because fungi are known to dissolve the rocks to release and translocate through their hyphae nutrients necessary for their growth. SN and SNN are depleted in Sr and enriched in ^Ca compared to the LCC. In the context of Villiers quarry, where the two ciystal shapes precipitate at similar temperature (in a range of 0,6°C), such variations are the result of a slower precipitation rate of NFC, which is inconsistent with a purely physicochemically precipitated elongate crystal.Finally, NFC is enriched in major and trace elements (i.e. Fe, Zn, Cu, and Mo) compared to the LCC. This enrichment is ascribed to modification in precipitation processes between the NFC and LCC. Right now, it is not possible to preclude the influence of the particular shape of NFC or the biological influence. REEs are not fractionated in NFC, contrary to LCC. Thus, NFC does not precipitate from a percolation solution circulating downward the soil, which should lead to the fractionation of the REEs. As explained above, fungi, are able to dissolve and translocate nutrients. This kind of processes allows releasing elements in the soil solution without fractionation and could explain the particular chemical signature of NFC regarding the REEs.The geochemical approach to investigate the origin of NFC presented in this study does not allow providing direct clues to the fungal origin of NFC, but brings several new insights in the understanding of the formation of such a particular mineral, calcite needles, by precluding definitively their physicochemical origin.RESUMELa calcite en aiguilles (NFC) est l'une des formes les plus ubiquiste de calcite pédogénique. Il s'agit d'un monocrystal de calcite d'un diamètre d'un micron et d'une longueur 4 à 102 fois supérieure à sa largeur. A l'échelle macroscopique, la NFC a été observée sous deux principaux aspects : l'une « cotonneuse » et l'autre formant un mince croûte autour des graviers du sol. La NFC peut également servir de support à la nucléation de ciments secondaires précipités de manière purement physico-chimique (LCC). Malgré les nombreuses études menées sur la NFC, son origine demeure encore inconnue. A ce jour, aucune expérience en laboratoire n'a permis de créer de la calcite en aiguilles, et ce, quelque soit l'approche abordée. Par conséquent, les processus précis responsables de la précipitation calcite avec une telle morphologie restent inconnus. Le décalage existant entre l'axe d'allongement des aiguilles de calcite et l'axe normal de croissance de la calcite (axe c) reste inexpliqué.Des échantillons de NFC, LCC, roche mère, eau de pluie des différents horizons du sol ont été prélevés principalement au front de deux carrières de graviers, ainsi que dans un profil de sol adjacent à ces carrières, dans le but de mieux comprendre les processus à l'origine de la précipitation de calcite en forme d'aiguille. Trois micro-morphologies ont été distinguées: les aiguilles simples (SN), les aiguilles simples avec surcroissances calcitiques (SNO) et enfin les aiguilles simples avec nanofibres (SNN), celles-ci pouvant être de minérales ou organiques. Ces groupes, d'après nos résultats et les études antérieures pourraient correspondre à différentes étapes de formation de la calcite en aiguilles.Dans un premier temps, la comparaison des signatures isotopiques de la calcite en aiguilles, du LCC, de la roche mère et du carbone inorganique dissout dans la solution du sol (CID) indique que la NFC, tout comme le LCC, précipite en équilibre avec la solution du sol. Les valeurs similaires en Ô13C et δ180 de cristaux de calcite allongés (NFC) et rhombohédriques (LCC) formés dans un même milieu suggère que ces différences morphologiques ne peuvent pas être attribuées à des modifications purement physico-chimiques. La croissance de NFC à l'intérieur d'un moule organique comme les hyphes de champignons semble être la seule hypothèse plausible permettant d'expliquer la formation de monocrystaux allongés de calcite en équilibre avec leur environnement.La composition isotopique en strontium (Sr) et calcium (Ca) des LCC et des trois micro¬morphologies de la NFC ont été étudiées également, afin de déterminer l'origine du Ca2+ présent dans le réseau cristallin de la calcite en aiguilles, ainsi que les processus responsables de la formation de NFC. Les valeurs du rapport 87Sr/86$r de la forme SN sont les plus proches de celles de la roche mère par rapport aux formes SNN et SNO et du LCC. Ceci pourrait être un nouvel indice de l'implication des champignons dans la précipitation de calcite en aiguilles, puisqu'ils sont connus pour avoir la capacité de dissoudre les roches afin de libérer les nutriments nécessaires à leur croissance, ainsi que de les transloquer par leurs hyphes. De plus, les formes SN et SNN sont appauvries en Sr et enrichies en "Ca, comparativement au LCC. Dans le sol étudié, tous les carbonates de calcium précipitent à la même température, par conséquent, de telles variations sont dues à un taux de précipitation plus lent de SN et SNN, ce qui est contradictoire avec l'hypothèse physico-chimique. Pour finir, la NFC est enrichie en certains éléments majeurs et traces (i.e. Fe, Zn, Cu et Mo) par rapport au LCC. Ceci peut être attribué à différents processus de formation entre la NFC et le LCC. Pour le moment il est impossible d'exclure l'influence de la forme particulière de la NFC ou celle du champignon. Les terres rares (REEs) ne sont pas fractionnées dans la NFC, contrairement au LCC. Ceci peut être expliqué par le fait que la NFC précipite à partir d'une solution qui n'a pas percolé à travers le sol. Les champignons en dissolvant les roches mettent en solution éléments sans les fractionner. L'approche géochimique de l'étude de la calcite en aiguilles ne permets pas de produire des preuves directes sur sa potentielle origine fongique, mais permet de mieux comprendre comment un minéral aussi singulier que la NFC peut se former. D'autre pare cette étude permets d'exclure définitivement l'hypothèse physico-chimique de l'origine de la calcite en aiguilles

Micro-ordinateurs de poche : du gadget à l'irremplaçable [Handheld computers: the gadget that became an invaluable tool]

Les ordinateurs de poche ont le potentiel de devenir un outil de travail indispensable pour le médecin praticien. De part une facilité d'utilisation toujours plus grande, un format ultra-portable, une grande capacité de stockage de l'information et de synchronisation à de multiples bases de données, ils permettent l'accès en tout temps et littéralement au lit du malade à une gamme complète de ressources médicales. Cet article se veut une lllustration des différentes possibilités d'utilisation de ces nouveaux outils, au travers de situations cliniques banales rencontrées par tout praticien.

Effects of nutrients and turbulence on the production of transparent exopolymer particles: a mesocosm study

The production of transparent exopolymer particles (TEP) in response to several environmental variables was studied in 2 mesocosm experiments. The first (Expt 1) examined a gradient of 4 nutrient levels; the second (Expt 2) examined different conditions of silicate availability and zooplankton presence. Tanks were separated in 2 series, one subjected to turbulence and the other not influenced by turbulence. In tanks with nutrient addition, TEP were rapidly formed, with net apparent production rates closely linked to chl a growth rates, suggesting that phytoplankton cells were actively exuding TEP precursors. High nutrient availability increased the absolute concentration of TEP; however, the relative quantity of TEP produced was found to be lower, as TEP concentration per unit of phytoplankton biomass was inversely related to the initial nitrate dose. In Expt 1, an increase in TEP volume (3 to 48 µm equivalent spherical diameter) with nutrient dose was observed; in Expt 2, both silicate addition and turbulence enhanced TEP production and favored aggregation to larger TEP (>48 µm). The presence of zooplankton lowered TEP concentration and changed the size distribution of TEP, presumably by grazing on TEP or phytoplankton. For lower nutrient concentrations, the ratio of particulate organic carbon (POC) to particulate organic nitrogen (PON) followed the Redfield ratio. At higher nutrient conditions, when nutrients were exhausted during the post-bloom, a decoupling of carbon and nitrogen dynamics occurred and was correlated to TEP formation, with a large flow of carbon channeled toward the TEP pool in turbulent tanks. TEP accounted for an increase in POC concentration of 50% in high-nutrient and turbulent conditions. The study of TEP dynamics is crucial to understanding the biogeochemical response of the aquatic system to forcing variables such as nutrient availability and turbulence intensity.

Bone mineral density (BMD), micro-architecture estimation (TBS) and vertebral fracture assessment (VFA) extracted from a single DXA device in combination with clinical risk factors improve significantly the identification of women at high risk of fracture.

Osteoporosis (OP) is a systemic skeletal disease characterized by a low bone mineral density (BMD) and a micro-architectural (MA) deterioration. Clinical risk factors (CRF) are often used as a MA approximation. MA is yet evaluable in daily practice by the trabecular bone score (TBS) measure. TBS is very simple to obtain, by reanalyzing a lumbar DXA-scan. TBS has proven to have diagnosis and prognosis values, partially independent of CRF and BMD. The aim of the OsteoLaus cohort is to combine in daily practice the CRF and the information given by DXA (BMD, TBS and vertebral fracture assessment (VFA)) to better identify women at high fracture risk. The OsteoLaus cohort (1400 women 50 to 80 years living in Lausanne, Switzerland) started in 2010. This study is derived from the cohort COLAUS who started in Lausanne in 2003. The main goal of COLAUS is to obtain information on the epidemiology and genetic determinants of cardiovascular risk in 6700 men and women. CRF for OP, bone ultrasound of the heel, lumbar spine and hip BMD, VFA by DXA and MA evaluation by TBS are recorded in OsteoLaus. Preliminary results are reported. We included 631 women: mean age 67.4 ± 6.7 years, BMI 26.1 ± 4.6, mean lumbar spine BMD 0.943 ± 0.168 (T-score − 1.4 SD), and TBS 1.271 ± 0.103. As expected, correlation between BMD and site matched TBS is low (r2 = 0.16). Prevalence of VFx grade 2/3, major OP Fx and all OP Fx is 8.4%, 17.0% and 26.0% respectively. Age- and BMI-adjusted ORs (per SD decrease) are 1.8 (1.2-2.5), 1.6 (1.2-2.1), and 1.3 (1.1-1.6) for BMD for the different categories of fractures and 2.0 (1.4-3.0), 1.9 (1.4-2.5), and 1.4 (1.1-1.7) for TBS respectively. Only 32 to 37% of women with OP Fx have a BMD < − 2.5 SD or a TBS < 1.200. If we combine a BMD < − 2.5 SD or a TBS < 1.200, 54 to 60% of women with an osteoporotic Fx are identified. As in the already published studies, these preliminary results confirm the partial independence between BMD and TBS. More importantly, a combination of TBS subsequent to BMD increases significantly the identification of women with prevalent OP Fx which would have been misclassified by BMD alone. For the first time we are able to have complementary information about fracture (VFA), density (BMD), micro- and macro architecture (TBS and HAS) from a simple, low ionizing radiation and cheap device: DXA. Such complementary information is very useful for the patient in the daily practice and moreover will likely have an impact on cost effectiveness analysis.