Impact of 18F-FDG PET scan on the prevalence of benign thoracic lesions at surgical resection

OBJECTIVE: The main utility of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) lies in the staging of lung cancer. However, it can also be used to differentiate indeterminate pulmonary lesions, but its impact on the resection of benign lesions at surgery is unknown. The aim of this study was to compare the prevalence of benign lesions at thoracotomy carried out for suspected lung cancer, before and after the introduction of PET scanning in a large thoracic surgical centre. MATERIALS AND METHODS: We reviewed our prospectively recorded surgical database for all consecutive patients undergoing thoracotomy for suspected or proven lung cancer and compared the prevalence of benign lesions in 2 consecutive 2-year groups, before (group I) and after (group II) the introduction of FDG-PET scan respectively. RESULTS: Surgical resection was performed on 1233 patients during the study period. The prevalence of benign lesions at surgery in groups I and II was similar (44/626 and 41/607, both 7%), and also in group II between those who underwent FDG-PET scan and the remainder (21/301 and 20/306 respectively, both 7%). In group II, of the 21 patients with benign lesions, who underwent FDG-PET, 19 had a false positive scan (mean standardised uptake value 5.3 [range 2.6-12.7]). Of these, 13 and 4 patients respectively had non-diagnostic bronchoscopy and percutaneous transthoracic lung biopsy pre thoracotomy. There was no difference in the proportion of different benign lesions resected between group I and those with FDG-PET in group II. CONCLUSION: The introduction of FDG-PET scanning has not altered the proportion of patients undergoing thoracotomy for ultimately benign lesions, mainly due to the avidity for the isotope of some non-malignant lesions. Such false positive results need to be considered when patients with unconfirmed lung cancer are contemplated for surgical resection.

Graduating 4th year radiology residents' perception of optimal imaging modalities for neoplasm and trauma: a pilot study from four U.S. universities

OBJECTIVE: Our purpose was to assess 4th year radiology residents' perception of the optimal imaging modality to investigate neoplasm and trauma. MATERIALS AND METHODS: Twenty-seven 4th year radiology residents from four residency programs were surveyed. They were asked about the best imaging modality to evaluate the brain and spine, lungs, abdomen, and the musculoskeletal system. Imaging modalities available were MRI, CT, ultrasound, PET, and X-ray. All findings were compared to the ACR appropriateness criteria. RESULTS: MRI was chosen as the best imaging modality to evaluate brain, spine, abdominal, and musculoskeletal neoplasm in 96.3%, 100%, 70.4%, and 63% of residents, respectively. CT was chosen by 88.9% to evaluate neoplasm of the lung. Optimal imaging modality to evaluate trauma was CT for brain injuries (100%), spine (92.6%), lung (96.3%), abdomen (92.6%), and major musculoskeletal trauma (74.1%); MRI was chosen for sports injury (96.3%). There was agreement with ACR appropriateness criteria. CONCLUSION: Residents' perception of the best imaging modalities for neoplasm and trauma concurred with the appropriateness criteria by the ACR.

Tratamento endovascular das doenças da aorta torácica: análise dos resultados de um centro

OBJETIVO: Analisar os resultados do tratamento de uma série consecutiva de pacientes submetidos a tratamento endovascular de doenças da aorta torácica. Foram observados o sucesso técnico, o sucesso terapêutico, a morbimortalidade e a taxa de complicações perioperatórias e de reintervenções. MATERIAIS E MÉTODOS: Estudo retrospectivo, realizado em um centro de referência, no período de janeiro de 2010 a julho de 2011, em que foram analisados pacientes submetidos a correção endovascular de doenças da aorta torácica. A população foi dividida em dois grupos: grupo 1 (G1) - aneurismas de aorta torácica verdadeiros, úlcera aórtica e pseudoaneurisma; grupo 2 (G2) - dissecção aórtica tipo B crônica. RESULTADOS: Em um total de 55 pacientes tratados, 29 pertenciam ao G1 e 26, ao G2. As idades médias foram 66,8 ± 10 e 56,4 ± 7 anos, respectivamente. Os sucessos técnico e terapêutico foram, respectivamente, 86,3% e 68,6% no G1 e 100% e 74% no G2. A mortalidade perioperatória foi 10,3% no G1 e 7,6% no G2, com taxa de mortalidade anual de 10,3% no G1 e de 19,3% no G2. As taxas de reintervenções foram 10,3% e 15,3%, respectivamente. CONCLUSÃO: Em nosso estudo, o tratamento endovascular das doenças da aorta torácica demonstrou ser um método viável e associado a aceitáveis taxas de complicações.

Evaluation of preoperative computed tomography angiography in association with conventional angiography versus computed tomography angiography only, in the endovascular treatment of aortic diseases

Objective To evaluate the association of conventional angiography (AG) with computed tomography angiography (CTA) as compared with CTA only, preoperatively, in the treatment of aortic diseases. Materials and Methods Retrospective study involving patients submitted to endovascular treatment of aortic diseases, in the period from January 2009 to July 2010, with use of preoperative CTA + conventional AG or CTA only. The patients were divided into two groups, namely: G1 – thoracic aortic diseases; and G2 – abdominal aortic diseases. G1 was subdivided into 1A (preoperative AG + CTA) and 1B (preoperative CTA). G2 was subdivided into 2C (CTA + AG) and 2D (CTA only). Results The authors evaluated 156 patients. In subgroups 1A and 1B, the rate of technical success was, respectively, 100% and 94.7% (p = 1.0); and the rate of therapeutic success was, respectively, 81% and 58% (p = 0.13). A higher number of complications were observed in subgroup 1B (p = 0.057). The accuracy in the calculation of the prosthesis was higher in subgroup 1A (p = 0.065). In their turn, the rate of technical success in subgroups 2C and 2D was, respectively, 92.3% and 98.6% (p = 0.17). The rate of therapeutic success was 73% and 98.6% (p = 0.79). Conclusion Preoperative conventional AG should be reserved for cases where CTA cannot provide all the information in the planning of a therapeutic intervention.

Kommentar zum schweizerischen Steuerrecht : Bundesgesetz über die Mehrwertsteuer (MWStG) / Loi fédérale régissant la taxe sur la valeur ajoutée (LTVA)

Comme impôt général sur la consommation, la TVA est omniprésente. Si le principe de base de cet impôt est simple, son application concrète s'avère des plus complexes. De nombreuses exceptions, exonérations et délimitations soulèvent continuellement des questions difficiles, lesquelles se posent avant tout aux contribuables eux-mêmes en raison du principe de l'auto-imposition. Près de cinq ans se sont désormais écoulés depuis l'entrée en vigueur de la nouvelle loi sur la TVA le 1er janvier 2010. De premières expériences ont été faites, de nombreuses directives administratives ont été édictées, de la jurisprudence a été rendue en la matière. Le nouveau commentaire se penche de manière approfondie sur ces nouveautés, de même que sur l'essentiel de la doctrine publiée. Il informe le praticien de manière pertinente, précise et complète sur tous les sujets importants du droit de la TVA et lui fournit des réponses concrètes aux questions posées dans la pratique. Les commentaires sont rédigés en partie en français et en partie en allemand.

El proceso del despido colectivo. Análisis de su régimen jurídico tras la reforma laboral de 2012 y del efecto de la crisis económica en el mercado de trabajo

La institució de l'acomiadament col·lectiu s'ha vist afectada per la reforma operada pel Reial Decret-llei 3/2012, de 10 de febrer, i la seva posterior convalidació com a Llei 3/2012, de 6 de juliol, de mesures urgents per a la reforma del mercat laboral. Els nombrosos pronunciaments i interpretacions proposades per diferents sectors judicials i doctrinals han convertit la regulació legal i reglamentària dels procediments d'acomiadament col·lectiu en un focus d'especial interès, sobretot tenint en compte la profunda crisi econòmica per la qual travessa Espanya. A causa d'això, podem assentar que gran part dels impediments al creixement de l'economia espanyola eren conseqüència de les febleses que mostrava el model laboral. És per aquest motiu que en el present treball ens dediquem a estudiar les diverses modificacions normatives dels expedients de regulació d'ocupació, prestant especial atenció als aspectes relatius a l'eliminació de la tradicional autorització administrativa (excepte pels casos de força major), a la significativa reconfiguració de les causes econòmiques, tècniques, organitzatives i productives que justifiquen l'extinció dels contractes de treball, al període de consultes, a la informació a facilitar als representants dels treballadors en el propi, a les actuacions de l'Autoritat Laboral per vetllar per la seva efectivitat del període de consultes podent realitzar funcions d'advertiment, recomanació i assistència a les parts, al renovat contingut de l'informe de la Inspecció de Treball i Seguretat Social, als plans de recol·locació i a les mesures d'acompanyament social assumides per l'empresari, entre d’altres. En definitiva, mitjançant el treball realitzat a continuació podem endinsar-nos a aquesta qüestió de forma més profunda i composar així un anàlisis extens sobre la reforma efectuada en 2012 en matèria d'acomiadaments col·lectius.

Smoking cessation and the incidence of pre-diabetes and type 2 diabetes : a cohort study

Le tabagisme est associé à un risque augmenté de développer un diabète de type 2. Arrêter de fumer devrait donc diminuer le risqué de diabète. Seulement, les études concernant le risque métabolique à l'arrêt du tabac sont discordantes. Par ailleurs, les effets métaboliques du tabac et de l'arrêt du tabac diffèrent probablement selon le sexe, avec notamment un effet différent du tabac sur la santé des femmes, et une prise pondérale plus importante à l'arrêt que chez les hommes. Notre étude vise à évaluer le risque métabolique à l'arrêt du tabac, chez les femmes et les homes séparément. Nous avons utilisé les données de l'étude de cohorte prospective CoLaus, qui évalue différents facteurs de risque cardiovasculaire chez des sujets choisis de manière aléatoire, dans la population Lausannoise entre 35 et 75 ans, suivis sur 5.5 ans en moyenne. Parmi ceux avec une glycémie à jeun normale au départ, nous avons divisé les participants en quatre groupes selon leur statut tabagique : non fumeurs, personnes ayant arrêté de fumer depuis plus de 5 ans, celles ayant arrêté depuis moins de 5 ans, et fumeurs actifs. Nous avons mesuré les incidences de glycémie à jeun altérée (5.6-6.99 mmol/l) et de diabète (glycémie à jeun ≥ 7 mmol/l et/ou traitement pour le diabète) durant le période de suivi, stratifiées par sexe. Puis le risque d'incidence de glycémie altérée et de diabète a été calculé avec trois niveaux d'ajustement pour les facteurs confondants pour un risque métabolique. Nous avons inclus 3166 participants, dont 63% de femmes. Au total, 26.3% étaient fumeurs, 6.5% ex-fumeurs depuis moins de 5 ans et 23.5% ex-fumeurs depuis plus de 5 ans. Durant le suivi, 1311 (41.4%) personnes ont développé une glycémie à jeun altérée (33.6% des femmes, 54.7% des homes), et 47 (1.5%) ont développé un diabète (1.1% des femmes, 2.1% des hommes). Les personnes ayant arrêté de fumer n'avait pas de risque significativement plus élevé de développer une glycémie à jeun altérée ou un diabète que les fumeurs, après ajustement pour l'âge, l'éducation, l'hypercholestérolémie, la prise d'alcool, l'activité physique, la prise de poids, le BMI initial et le BMI d'arrivée dans les différents modèles d'ajustement. L'analyse de l'interaction du sexe avec ces résultats est également négative. Les analyses de sensibilité ont montré que l'exclusion des personnes ayant changé de statut tabagique durant le suivi ne changeait pas ces résultats. Nous avons refait les analyses en incluant les participants ayant une glycémie altérée au début du suivi, mais le risque d'incidence de diabète n'est pas plus élevé chez les ex-fumeurs que chez les fumeurs non plus dans cette population. Sur demande d'un reviewer, nous avons également refait les analyses avec la glycémie en continue (valeurs de base et valeurs à 5.5 ans), et la glycémie moyenne n'était pas différente par groupe de tabagisme. En conclusion, dans cette population européenne d'âge moyen, avec une prévalence basse d'obésité et une prise de poids modérée durant le suivi, nous n'avons pas trouvé de risque significativement plus élevé de développer un diabète en arrêtant de fumer, et ce pour les deux sexes. L'arrêt du tabac doit donc être encouragé chez toutes les fumeuses et tous les fumeurs.

Ohjauksen ja neuvonnan vaikutukset sepelvaltimoiden ohitusleikkauspotilaiden terveyskäyttäytymiseen, terveyteen ja toimintakykyyn

Effects of counseling and guidance on health behavior, health, and functional abilities of coronary artery bypass (cab) patients Hospital periods of heart patients are brief and full of activity today, and for that reason, the meaning of counseling and guidance becomes emphasized. The present intervention study started based on observations of staff members at the heart organization. According to these observations, there were gaps in counseling and guidance intended for coronary artery bypass (CAB) patients. The purpose of the present intervention study was to describe and evaluate the program on counseling and guidance organized for patients who were referred to CAB operations. More specifically, the study was to assess its short-term (3-month), intermediate (6-month), and long-term (12-month) effects on health behavior, health, and functional abilities of CAB patients of any age on one hand and elderly on the other, as well as on their mortality. The data consisted of those individuals having coronary heart disease (CHD) and living in Uusimaa (n = 365) who went through their first CAB operation at the Helsinki University Hospital between May 7th, 1998 and December 31st, 2001. Based on the need of urgency, they were divided into two groups: 1) surgery with regular referral procedure (non-acute) or 2) surgery in the acute phase of CHD. Randomization into an intervention and a control group was separately carried out within these two groups. A subgroup was formed by including those 65 years or older who were operated on with regular referral procedure. Data on health behavior, health, and functional abilities were gathered with survey questionnaires. Times and causes of death were examined January 1st, 1998 through December 31st, 2004. Intervention included counseling and guidance in small groups. The intervention of the non-acutely operated patients was implemented prior to and following surgery, whereas the intervention of the acutely operated patients was implemented after surgery alone. The control group received regular health care services. Counseling and guidance contributed in positive terms to the frequency of alcohol use among non-acutely operated men and to the frequencies of exercise and functional ability among women. The intervention was also capable of having an effect on the exercise frequencies of elderly and acutely operated men. The present intervention did not have an effect on the body mass index, whereas it had barely a slight effect on the health status of the CAB patients. The findings of the intervention and generalizations resulting from them must be viewed critically because the data analysis utilized a multi-testing situation, many variables, and several subgroups. The study did not involve intention to treat analysis. Additionally, a loss of patients was great especially among the elderly and acutely operated patients.

Ruostumattomien terästen kuitulaserleikkaus

Työ jakaantuu kirjalliseen tutkimukseen sekä kokeelliseen osaan. Työn kirjallisuustutkimus käsittelee laserleikkausta yleisesti ja kartoittaa tämän hetken tilannetta kuitulaserin mahdollisuuksista ruostumattomien terästen leikkauksessa. Työn kokeellinen osuus käsittelee ruostumattomien terästen kuitulaserleikkauksesta levypaksuuksilla 3 mm ja 6 mm. Kokeissa tutkitaan leikkauspään leikkaussuunnan mukaisen kulman muutoksen vaikutusta leikkausnopeuteen. Leikkauksissa määritetään neljälle eri leikkauspään kulmalle suurin mahdollinen leikkausnopeus.

Adsorção de zinco e cádmio em colunas de turfa

The aim of this work was to evaluate the adsorption conditions of zinc and cadmium ions from aqueous solutions using a comercially available peat from Balneário Arroio do Silva, Santa Catarina State, Brazil. Adsorption studies were carried out in column experiments using radiotracers of the studied metals (65Zn and 115Cd). The pH influence and the interference of other ions, such as Na+, Ca2+, Fe3+ and Al3+on the adsorption process were investigated. The results showed that peat columns are able to retain more than 99% of metal ions in solution in a range of pH from 3,7 to 6,5. Ca2+ and Al3+ ions were the main interferent on adsorption of Zn and Cd ions in solution.

Fotoquímica de chalconas fluoradas no estado sólido

Chalcone and its fluorinated derivatives were synthesized and photolyzed in the solid state. UV irradiation of chalcone and its monosubstituted fluorine derivatives (3- and 4-fluorchalcone) resulted in a mixture of anti-head-head (gamma-truxinic), sin-head-tail (alpha-truxilic) and anti-head-tail (epsilon-truxilic) dimers. On the other hand, upon irradiation of 3,4- and 3,5-difluorchalcone a stereoselective formation of the alpha-truxilic photodimer was observed, whereas for 2-substituted chalcones (2,3difluorchalcone, 2,5-difluorchalcone, 2,6-difluorchalcone and 2,3,4-trifluorchalcone) the beta-truxilic dimer was stereoselectively obtained. 2',3',4',5',6'-pentafluorchalcone was the less reactive of all chalcones studied and at least one of the possible photodimers, i.e the anti-head-head isomer, was identified. Irradiation of polyfluorinated chalcones such as 2,3,5,6-tetrafluor-, 2,3,4,5,6-pentafluor-, and 2,2',3,3',4,4',5,5',6,6'-decafluorchalcone led only to polymerization and/or decomposition products.

ESTRO-HERO survey: Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey

Background: The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database. Materials and methods: An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 4760), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO). Results: A large variation between countries was found for most parameters studied. Averages and ranges for personnel numbers per million inhabitants are 12.8 (2.530.9) for radiation oncologists, 7.6 (019.7) for medical physicists, 3.5 (012.6) for dosimetrists, 26.6 (1.978) for RTTs and 14.8 (0.461.0) for radiotherapy nurses. The combined average for physicists and dosimetrists is 9.8 per million inhabitants and 36.9 for RTT and nurses. Radiation oncologists on average treat 208.9 courses per year (range: 99.9348.8), physicists and dosimetrists conjointly treat 303.3 courses (range: 85757.7) and RTT and nurses 76.8 (range: 25.7156.8). In countries with higher GNI per capita, all personnel categories treat fewer courses per annum than in less affluent countries. This relationship is most evident for RTTs and nurses. Different clusters of countries can be distinguished on the basis of available personnel resources and socio-economic status. Conclusions: The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants, but also the stage in technology adoption along with treatment complexity and the different professional roles and responsibilities within each country. Our data underpin the need for accurate prediction models and long-term education and training programmes

Estudo eletroanalítico do herbicida paraquat em soluções aquosas por voltametria de onda quadrada utilizando ultramicroeletrodos

The electrochemical behavior of paraquat on Pt, Au and carbon fiber ultramicroelectrodes were studied in laboratory samples by square wave voltammetry at high frequencies. The results showed two reversible peaks for paraquat reduction, in agreement to the literature data. The first peak was associated to the reduction of paraquat molecule in solution, with the further adsorption of the intermediate on the electrode surface. This adsorbed species undergoes to electroreduction in a reaction associated to the second voltammetric peak. The variation in pH and square wave parameters showed the best conditions to reduce paraquat as pH 5.0, frequency as high as 1000 s-1, scan increment of 2 mV and square wave amplitude of 50 mV. At such conditions, a variation of paraquat concentrations from 4.3 x 10-6 to 1.66 x 10-4 mol L-1 presented values for the detection limit equal to 3.9, 6.2 and 20.3 ppb on Pt, Au and carbon, respectively, at 1000 s-1. These values are quite below17 the allowed limit of paraquat in drinking water.