EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe

Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. Methods: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method. Results: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. Conclusions: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.

Biotechnology applied to Annona species: a review

Annonaceae is an ancient family of plants including approximately 50 genera growing worldwide in a quite restricted area with specific agroclimatic requirements. Only few species of this family has been cultivated and exploited commercially and most of them belonging to the genus Annona such as A. muricata, A. squamosa, the hybrid A. cherimola x A. squamosa and specially Annona cherimola: the cherimoya, commercially cultivated in Spain, Chile, California, Florida, México, Australia, Ecuador, Peru, Brazil, New Zealand and several countries in South and Central America. The cherimoya shows a high degree of heterozygosis, and to obtain homogeneous and productive orchards it is necessary to avoid the propagation by seeds of this species. Additionally, the traditional methods of vegetative propagation were inefficient and inadequate, due to the low morphogenetic potential of this species, and the low rooting rate. The in vitro tissue culture methods of micropropagation can be applied successfully to cherimoya and other Annona sp to overcome these problems. Most of the protocols of micropropagation and regeneration were developed using the cultivar Fino de Jete, which is the major cultivar in Spain. First it is developed the method to micropropagate the juvenile material of cherimoya (ENCINA et al., 1994), and later it was optimized a protocol to micropropagate adult cherimoya genotypes selected by outstanding agronomical traits (PADILLA and ENCINA, 2004) and further it was improved the process through micrografting (PADILLA and ENCINA, 2011).At the present time we are involved in inducing and obtaining new elite genotypes, as part of a breeding program for the cherimoya and other Annonas, using and optimizing different methodologies in vitro: a) Adventitious organogenesis and regeneration from cellular cultures (ENCINA, 2004), b) Ploidy manipulation of the cherimoya, to obtain haploid, tetraploid and triploid plants (seedless), c) Genetic transformation, for the genes introduction to control the postharvest processes and the genes introduction to provide resistance to pathogen and insects and d) Micropropagation and regeneration of other wild Annona or related Annonaceae species such as: Annona senegalensis, A. scleroderma, A. montana, A. reticulata, A. glabra, A. diversifolia and Rollinia sp.

Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data.

BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 °C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.

Osteopaattisen hoidon vaikutukset purentaelimen dysfunktion oireisiin

Tämän opinnäytetyön tarkoituksena oli selvittää osteopaattisten manuaalisen hoidon vaikutusta purentaelimen dysfunktiosta johtuviin oireisiin. Lisäksi teimme osteopaattisen tutkimus- ja hoitomallin osteopaattien käyttöön. Tutkimukseen osallistui kaksitoista potilasta. Erikoishammaslääkäri, professori Pentti Kemppainen valikoi YTHS:n potilaskannasta opinnäytetyöhön tulevat potilaat ja HLL Seija Taube teki valituille potilaille aloitusvaiheen hammaslääketieteellisen purentafysiologisen tutkimuksen. Opinnäytetyöhön ei otettu potilaita, joiden vaivana olivat yliliikkuvat leukanivelet, leukanivelen nivelrikko tai leukanivelten reuma yms. sairaudet. Valintakriteereinä olivat tutkimushenkilöiden kokema kipu posken ja ohimon alueella ja leukanivelen liikerajoitus. Tutkimus ja hoitokertoja oli neljä, viikon välein. Ensimmäisellä hoitokerralla potilaat vastasivat kyselylomakkeeseen, jossa kartoitimme VAS- janan avulla, oliko heillä ilmennyt viimeisen 6kk aikana päänsärkyä, kipua pureskellessa ja kipua suuta avatessa. Kartoitimme kyselylomakkeessa myös oliko heillä ollut leukanivelen naksumista, lukkiutumista, korvien tukkoisuutta ja korvien soimista. Osteopaattinen hoito koostui lihastekniikoista, leukanivelen artikulaatiosta, lihaskalvoihin kohdistuvista tekniikoista ja kraniaalitekniikoista. Viimeisen käynnin yhteydessä potilaat saivat saman kyselylomakkeen kuin tullessa. Lisäksi kysyimme kokivatko he oireiden lievittyneen hoitojakson jälkeen ja oliko potilaista hoidolla ollut vaikutusta oireiden lievittymiseen. Pyysimme potilaita vastaamaan lomakkeeseen viikon kuluttua viimeisestä hoitopäivästä. Hoidot toteutettiin Kunto-Stadian tiloissa keväällä 2006. Tutkimustulokset on analysoitu Wilcoxonin merkkitestillä. Tutkimustuloksista tilastollisesti merkitsevä muutos oli päänsäryn väheneminen (P=0,004).

Levantamento da distribuição de equipamentos de diagnóstico por imagem e freqüência de exames radiológicos no Estado de São Paulo

OBJETIVO: Realizar um levantamento no Estado de São Paulo das informações referentes a equipamentos de diagnóstico por imagem e exames radiológicos. MATERIAIS E MÉTODOS: Essas informações foram obtidas através do Departamento de Informática do Sistema Único de Saúde (Datasus). A distribuição de equipamentos e a freqüência anual de exames foram analisadas considerando-se as diferentes regiões de saúde (Diretorias de Saúde) que compõem o Estado e suas respectivas populações. RESULTADOS: Os resultados obtidos apontam para diferenças regionais significativas, tanto em relação à distribuição de equipamentos como à freqüência de exames. Comparações com dados disponíveis de outros países indicam que pode haver demanda por parte da população em relação a exames de diagnóstico por imagem, principalmente no caso de mamografia, embora o acesso público a esses serviços tenha melhorado nos últimos anos. CONCLUSÃO: Estudos como este demonstram a importância da democratização das informações do sistema de saúde do País e contribuem para uma análise sistemática e objetiva de áreas específicas, servindo de referência para futuros trabalhos.

Partnering in the Dynamic Environment: The Role of Trust in Asymmetric Technology Partnership Formation

The purpose of this study was to increase the understanding of the role and nature of trust in asymmetric technology partnership formation. In the knowledge-based "learning race" knowledge is considered as a primary source for competitive advantage. In the emerging ICT sector the high pace of technological change, the convergence of technologies and industries as well as the increasing complexity and uncertainty have forced even the largest players to seek cooperation for complementary knowledge and capabilities. Small technology firms need the complementary resources and legitimacy of the large firms to grow and compete in the global market place. Most of the earlier research indicates, however, that partnerships with asymmetric size, managerial resources and cultures have failed. A basic assumption supported by earlier research was that trust is a critical factor in asymmetric technology partnership formation. Asymmetric technology partnership formation is a dynamic and multi-dimensional process, and consequently a holistic research approach was selected. Research issue was approached from different levels: the individual decision-maker, the firm and the relationship between the parties. Also the impact of the dynamic environment and technology content was analyzed. A multitheoretical approach and a qualitative research method with in-depth interviews in five large ICT companies and eight small ICT companies enabled a holistic and rich view of the research issue. Study contributes on the scarce understanding on the nature and evolution of trust in asymmetric technology partnership formation. It sheds also light on the specific nature of asymmetric technology partnerships. The partnerships were found to be tentative and the diverse strategic intent of small and large technology firms appeared as a major challenge. The role of the boundary spanner was highlighted as a possibility to match the incompatible organizational cultures. A shared vision was found to be a pre-condition for individual-based fast trust leading to intuitive decision-making and experimentation. The relationships were tentative and they were continuously re-evaluated through the key actors' sense making of the technology content, asymmetry and the dynamic environment. A multi-dimensional conceptualization for trust was created and propositions on the role and nature of trust for further research are given. The purpose of this study was to increase the understanding of the role and nature of trust in asymmetric technology partnership formation. In the knowledge-based "learning race" knowledge is considered as a primary source for competitive advantage. In the emerging ICT sector the high pace of technological change, the convergence of technologies and industries as well as the increasing complexity and uncertainty have forced even the largest players to seek cooperation for complementary knowledge and capabilities. Small technology firms need the complementary resources and legitimacy of the large firms to grow and compete in the global market place. Most of the earlier research indicates, however, that partnerships with asymmetric size, managerial resources and cultures have failed. A basic assumption supported by earlier research was that trust is a critical factor in asymmetric technology partnership formation. Asymmetric technology partnership formation is a dynamic and multi-dimensional process, and consequently a holistic research approach was selected. Research issue was approached from different levels: the individual decision-maker, the firm and the relationship between the parties. Also the impact of the dynamic environment and technology content was analyzed. A multitheoretical approach and a qualitative research method with in-depth interviews in five large ICT companies and eight small ICT companies enabled a holistic and rich view of the research issue. Study contributes on the scarce understanding on the nature and evolution of trust in asymmetric technology partnership formation. It sheds also light on the specific nature of asymmetric technology partnerships. The partnerships were found to be tentative and the diverse strategic intent of small and large technology firms appeared as a major challenge. The role of the boundary spanner was highlighted as a possibility to match the incompatible organizational cultures. A shared vision was found to be a pre-condition for individual-based fast trust leading to intuitive decision-making and experimentation. The relationships were tentative and they were continuously re-evaluated through the key actors' sense making of the technology content, asymmetry and the dynamic environment. A multi-dimensional conceptualization for trust was created and propositions on the role and nature of trust for further research are given.