Use of CPAP to Reduce Arterial Stiffness in Moderate-to-Severe Obstructive Sleep Apnoea, Without Excessive Daytime Sleepiness (STIFFSLEEP): an Observational Cohort Study Protocol

INTRODUCTION: Sleepiness is a cardinal symptom in obstructive sleep apnoea (OSA) but most patients have unspecific symptoms. Arterial stiffness, evaluated by pulse wave velocity (PWV), is related to atherosclerosis and cardiovascular (CV) risk. Arterial stiffness was reported to be higher in patients with OSA, improving after treatment with continuous positive airway pressure (CPAP). This study aims to assess whether the same effect occurs in patients with OSA and without sleepiness. METHODS AND ANALYSIS: This observational study assesses the CV effect of CPAP therapy on a cohort of patients with moderate-to-severe OSA; the effect on the subcohorts of sleepy and non-sleepy patients will be compared. A systematic and consecutive sample of patients advised CPAP therapy will be recruited from a single outpatient sleep clinic (Centro Hospitalar de Lisboa Central-CHLC, Portugal). Eligible patients are male, younger than 65 years, with confirmed moderate-to-severe OSA and apnoea-hypopnea index (AHI) above 15/hour. Other sleep disorders, diabetes or any CV disease other than hypertension are exclusion criteria. Clinical evaluation at baseline includes Epworth Sleepiness Scale (ESS), and sleepiness is defined as ESS above 10. OSA will be confirmed by polygraphic study (cardiorespiratory, level 3). Participants are advised to undertake an assessment of carotid-femoral PWV (cf-PWV) and 24 hours evaluation of ambulatory blood pressure monitoring (ABPM), at baseline and after 4 months of CPAP therapy. Compliance and effectiveness of CPAP will be assessed. The main outcome is the variation of cf-PWV over time.

Symptom Clusters and Survival in Portuguese Patients with Advanced Cancer

This study aimed to identify clusters of symptoms, to determine the patient characteristics associated with identified, and determine their strength of association with survival in patients with advanced cancer (ACPs). Consecutively eligible ACPs not receiving cancer-specific treatment, and referred to a Tertiary Palliative Care Clinic, were enrolled in a prospective cohort study. At first consultation, patients rated 9 symptoms through the Edmonton Symptom Assessment System (0-10 scale) and 10 others using a Likert scale (1-5). Principal component analysis was used in an exploratory factor analysis to identify. Of 318 ACPs, 301 met eligibility criteria with a median (range) age of 69 (37-94) years. Three SCs were identified: neuro-psycho-metabolic (NPM) (tiredness, lack of appetite, lack of well-being, dyspnea, depression, and anxiety); gastrointestinal (nausea, vomiting, constipation, hiccups, and dry mouth) and sleep impairment (insomnia and sleep disturbance). Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter survival was observed for patients with the NPM cluster (58 vs. 23, P < 0.001), as well as for patients with two or more SCs (45 vs. 21, P = 0.005). In a multivariable model for survival at 30-days, age (HR: 0.98; 95% CI: 0.97-0.99; P = 0.008), hospitalization at inclusion (HR: 2.27; 95% CI: 1.47-3.51; P < 0.001), poorer performance status (HR: 1.90, 95% CI: 1.24-2.89; P = 0.003), and NPM (HR: 1.64; 95% CI: 1.17-2.31; P = 0.005), were associated with worse survival. Three clinically meaningful SC in patients with advanced cancer were identifiable. The NPM cluster and the presence of two or more SCs, had prognostic value in relation to survival.

Analyse de la valeur pronostique du contexte immunologique du cancer superficiel de la vessie

Le cancer de la vessie est le 5e plus répandu au Canada. Les tumeurs vésicales non-infiltrant le muscle (TVNIM) représentent 70-75% des tumeurs au premier diagnostic. Après une résection transurétrale de tumeur de vessie (RTUTV), 60-70 % des patients souffriront de récidive et 10-20 % de progression vers l’infiltration du muscle (TVIM). Présentement, l’évaluation du risque de récidive ou de progression pour sélectionner le traitement approprié est basée sur les caractéristiques cliniques et pathologiques. La gestion des TVNIM à haut risque est l’un des aspects les plus difficiles à gérer pour un uro-oncologue et il est bien connu que l’issue clinique peut varier significativement entre des patients ayant une tumeur de même stade. Il serait donc important de détecter les tumeurs les plus susceptibles de récidiver et de progresser pour ajuster le traitement en conséquence. L’objectif de mon projet était d’analyser la valeur pronostique du contexte immunologique des TVNIM pour prédire leurs probabilités de récidive ou de progression vers l’infiltration du muscle. Mon premier volet consistait à évaluer la valeur pronostique de l’infiltration des cellules immunes, telles que les cellules dendritiques infiltrant les tumeurs (TIDC), les cellules T infiltrant les tumeurs (TIL) et les macrophages associés aux tumeurs (TAM) dans une cohorte de 106 TVNIM initiales. Les données d’infiltration des TIDC et des TIL dans les TVNIM démontrent leur importance dans l’évolution des patients atteints du cancer de la vessie et pourraient aider à identifier les TVNIM à haut risque. Mon deuxième volet consistait à caractériser un profil d’expression génique associé aux immunités innée et adaptative dans une série de 22 TVNIM. Cependant, le faible nombre de tumeurs disponibles a empêché d’obtenir une conclusion. Notre étude a permis de confirmer que la composition et le phénotype des cellules immunes infiltrant les TVNIM ont un impact sur l’évolution de ces tumeurs.

Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience

Background. Surgical treatment of varicose veins of the lower limbs resolves symptoms and improves quality of life. However, the high recurrence (20-80%) is a costly and complex issue. Patients and methods. This is a retrospective review of 1489 patients with varicose vein of the lower limbs seen at our hospital between January 1980 and December 2005. The aim is to evaluate the effect of surgical technique (stripping vs. CHIVA) and surgeon’s experience in reducing recurrences. Results. With experienced surgeons, CHIVA appears to be more effective than stripping in reducing the recurrence rate (p <0.05). However, when performed by an inexperienced surgeon the results are far worse than those achieved with stripping. Conclusion. There was a clear reduction in recurrences at 5-10 years with CHIVA than with conventional stripping. However, if performed incorrectly, results are far worse with CHIVA. In fact, good results are far more difficult to achieve with CHIVA than with stripping, which is repeatable and easy to perform.

Factors affecting the prognosis of Albanian adult patients with generalized tetanus

Background. Despite systematic vaccination of the population, tetanus continues to be a health problem in Albania, as in some other developing countries. In this study, our intent was to evaluate prognostic factors relating to death in adult patients with generalized tetanus. Methodology and patients. All the patients (60) included in the study were hospitalized at the regional hospitals of Shkodra and Korça, and the University Hospital Centre “Mother Theresa” of Tirana, Albania, during the period of 1984-2004. They had a mean age of 49.1+14.4 years, 43 (71.7%) were males and 40 (66.6%) of them lived in rural areas. The mean incubation period was 12 days and the case-fatality rate (CFR) was 38.3%. Results. The CFR in patients with an onset period ≥2 days was 21.7% and in those with <2 days was 48.6%, OR=0.29 (p<0.05). Patients >50 years old had a CFR=60.87% (OR=7, p<0.05). We found the high CFR to be significantly associated with urban residency, male gender, complicated wound, head localization, fever ≥ 38.4 °C, tachycardia > 120 beats/min, and hypertension. Discussion. The main prognostic factor of those analyzed in our study appeared to be the onset period and the age of the patients. We didn’t find significant differences in CFR in patients with different incubation periods. Clinicians must take into account that wound complication and localization, tachycardia and hypertension, high fever, male gender and urban residency significantly influence the prognoses of adults with generalized tetanus.

Sedimenttexturen der Sohlbankfläche im Naturdenkmal "Saurierfährten Münchehagen" (Berrias), Rehburger Berge : Rippelmarken und Ichnofossilien als Grundlage einer Deutung des Ablagerungsraumes

Die Gesteine des bearbeiteten Aufschlusses, dem Naturdenkmal "Saurierfährten Münchehagen" bei Münchehagen (Rehburger Berge), liegen stratigraphisch in der Bückeberg-Formation des Berrias (Wealden). Aufgeschlossen ist der Hauptsandstein (Wealden 3) . Es werden die Sedimenttexturen der Sohlbankfläche des ehemaligen Steinbruchs analysiert und interpretiert. Vorherrschende Schichtungstypen sind Wellenrippelschichtung und Flaserschichtung. Die Sedimente sind stark bioturbat. Auf mehreren freiliegenden Flächenniveaus der Sohlbank sind Rip- pelmarken zu beobachten, die systematisch vermessen wurden. Danach handelt es sich uro Wellenrippeln und untergeordnet um strömungsüberformte Wellenrippeln durch ablaufendes Wasser. Zahlreiche Merkmale zeigen wiederholtes Auftauchen und Trok- kenfallen an. Tonlagen kennzeichnen zeitweilige Stillwasserbedingungen. Ein ehemals verzweigtes Rinnensystem ist in Relikten erhalten und beweist ebenfalls einen wechselnden Wasserstand (ablaufendes Wasser). Sporadisch kam es im Zuge hochenergetischer Ereignisse zu einem schichtflutartigen Abfließen des Wassers. Eine reiche Ichnofauna ist zu beobachten. Wenige Spurentypen sind vorhanden, die Spurendichte ist jedoch sehr hoch. Es dominieren horizontale oder wenig geneigte Gestaltungswühlgefüge, vertikale Bauten kommen nur untergeordnet vor. Als häufigste Spurentypen treten Thalassinoides, Muensteria, Plano- lites und Pelecypodichnus auf. Die Größe der Ichnofossilien ist meist gering. Die Spuren bilden eine Ichnocoenose aus Ichnofossilien der Cruziana- und untergeordnet der Skolithos- Fazies. Bivalven belegen Brackwasser-Verhältnisse. Dies alles sind Merkmale eines lagunären Ablagerungsraumes, gelegen am Rand eines gezeitenarmen bzw. -losen Nebenmeeres (Niedersächsisches Becken) im Übergang von der fluviatilen in die litorale Fazies im rückwärtigen Bereich eines Barrierensystems. Wahrscheinlich spielte Wind eine entscheidende Rolle als Ursache für Wasserspiegelschwankungen. Die maximale Wassertiefe bei auflandigem Sturm hat vermutlich nicht mehr als 3 - 4 m betragen. Sonst war sie wahrscheinlich deutlich geringer und ermöglichte Dinosauriern ein Durchwaten des Gewässers, wie Fährten auf der Sohlfläche beweisen.

The method is design: towards a handbook of design research tactics

New Zealand's schools of architecture are unique in the Australasian context, in that the fifth year of study for students takes the form of a 12-month research thesis. This structure prompts reflection on research through the medium of design, which we will explore here in the context of the Victoria University of Wellington (VUW).

But with recent developments in digital technology, new materials and construction practices, shifts in the client-architect relationship, and architectural practice subject to evermore-onerous procurement models, is the studio model still ...

Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study

BACKGROUND: The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks. METHOD: In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976. FINDINGS: Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic prostatectomy and 163 to robot-assisted laparoscopic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group proceeded to surgery and 157 in the robot-assisted laparoscopic prostatectomy group. 121 assigned to radical retropubic prostatectomy completed the 12 week questionnaire versus 131 assigned to robot-assisted laparoscopic prostatectomy. Urinary function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (74·50 vs 71·10; p=0·09) or 12 weeks post-surgery (83·80 vs 82·50; p=0·48). Sexual function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (30·70 vs 32·70; p=0·45) or 12 weeks post-surgery (35·00 vs 38·90; p=0·18). Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs 23 [15%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p=0·21). 14 patients (9%) in the radical retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p=0·052). 12 (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events. INTERPRETATION: These two techniques yield similar functional outcomes at 12 weeks. Longer term follow-up is needed. In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach. FUNDING: Cancer Council Queensland.

Nurse-led group consultation intervention reduces depressive symptoms in men with localised prostate cancer: a cluster randomised controlled trial

BACKGROUND: Radiotherapy for localised prostate cancer has many known and distressing side effects. The efficacy of group interventions for reducing psychological morbidity is lacking. This study investigated the relative benefits of a group nurse-led intervention on psychological morbidity, unmet needs, treatment-related concerns and prostate cancer-specific quality of life in men receiving curative intent radiotherapy for prostate cancer.

METHODS: This phase III, two-arm cluster randomised controlled trial included 331 men (consent rate: 72 %; attrition: 5 %) randomised to the intervention (n = 166) or usual care (n = 165). The intervention comprised four group and one individual consultation all delivered by specialist uro-oncology nurses. Primary outcomes were anxious and depressive symptoms as assessed by the Hospital Anxiety and Depression Scale. Unmet needs were assessed with the Supportive Care Needs Survey-SF34 Revised, treatment-related concerns with the Cancer Treatment Scale and quality of life with the Expanded Prostate Cancer Index -26. Assessments occurred before, at the end of and 6 months post-radiotherapy. Primary outcome analysis was by intention-to-treat and performed by fitting a linear mixed model to each outcome separately using all observed data.

RESULTS: Mixed models analysis indicated that group consultations had a significant beneficial effect on one of two primary endpoints, depressive symptoms (p = 0.009), and one of twelve secondary endpoints, procedural concerns related to cancer treatment (p = 0.049). Group consultations did not have a significant beneficial effect on generalised anxiety, unmet needs and prostate cancer-specific quality of life.

CONCLUSIONS: Compared with individual consultations offered as part of usual care, the intervention provides a means of delivering patient education and is associated with modest reductions in depressive symptoms and procedural concerns. Future work should seek to confirm the clinical feasibility and cost-effectiveness of group interventions.

Prácticas de la educación física

Tabla de contenidos: La formación de formadores y de profesores de Educación Física en Brasil: la tensión entre la producción de conocimiento y la identidad epistemológica / Santiago Pich. La gestión universitaria como articulación política, académica y comunitaria / Fabián Horacio Martins. La universidad y las nuevas configuraciones sociales y educativas / Daniel Zambaglione. Perspectivas y nuevos desafíos de las prácticas de investigación y extensión / Susana Ortale. La construcción de desafíos en el hacer político-académico de la investigación y la extensión universitarias / Osvaldo Omar Ron. Las prácticas gimnásticas, expresivas, ludomotrices, deportivas y en relación con el ambiente natural en la Educación Física del sistema educativo de la provincia de Buenos Aires / Liliana Mosquera. La perspectiva de la comprensión en la Educación Física de la escuela secundaria y el enfoque de la complejidad en la educación profesional / José Antonio Fotia. Los estudios de prácticas corporales urbanas desde la perspectiva de las ciencias sociales. Aportes al campo de la Educación Física / Jorge Ricardo Saraví. Qué es y para qué sirve la antropología del deporte / José Garriga Zucal. El deporte ¿templa el espíritu o enajena las conciencias? Preguntas para una sociología del deporte lo menos normativa posible / Rodolfo Martín Iuliano. El artificio del juego. Un diálogo posible entre educación, enseñanza y trasmisión / Jorge Daniel Nella. Perspectivas de análisis en estudios vinculados a la gimnasia / Sergio Horacio Lugüercho. El rendimiento en los deportes acíclicos: algunos tópicos de interés / Adrián Casas. El entrenamiento de la fuerza muscular y la prevención de lesiones en deportistas / Fernando Naclerio. El corazón del deportista: prevención y riesgo en la competición / Roberto Peidro. Hacia un cambio de paradigma en la práctica profesional de la Educación Física / Gabriel Omar Tarducci. Problemas con el cuerpo / el cuerpo en problemas / María Luisa Femenías. Ciudad, cuerpo y movimiento. Elementos para una antropología de la movilidad urbana / Ramiro Segura. Hacia una (re)politización de los cuerpos. Educación Física, higienismo, eugenesia y Estado / Eduardo Galak. Prolegómenos del código disciplinar de la Educación Física en España. El buen gobierno del cuerpo en clave de género en la obra de Josefa Amar y Borbón / Miguel Vicente Pedraz. Las prácticas de sí y una estética de la existencia. Problematizaciones en torno a la Educación Corporal / Norma Beatriz Rodríguez. Prácticas corporales y usos del cuerpo: sobre lo que podemos no hacer / Liliana Rocha Bidegain. Un análisis para pensar las prácticas con el cuerpo, no por el cuerpo / Agustín Amílcar Lescano. Prácticas de inclusión en Educación Física / Marli Nabeiro. Nuevas perspectivas en la formación de profesores de Educación Física en relación con la discapacidad / Sandra Lea Katz. Representaciones sociales, prácticas de inclusión y de integración social en el campo de la Educación Física con adultos mayores / Débora Paola Di Domizio. Infancia e inclusión: una cuestión de derechos / Laura Chiani. ¿De quién depende la implementación de políticas públicas inclusivas? Perspectivas y experiencias en la Universidad Nacional de Río Cuarto / Claudio Daniel Aruza. La responsabilidad de las instituciones como promotoras de políticas públicas en inclusión e integración social / Laura Mercedes Sosa. ¿Historia de la Educación Física o historia en la Educación Física? / Laura Marcela Méndez. Las feministas y su "mirada" sobre la Educación Física "femenina". Argentina, primeras décadas del siglo XX / Pablo Ariel Scharagrodsky. Ley, medios y prácticas deportivas: de la información como negocio al derecho a la comunicación / Nancy Díaz Larrañaga. Los medios y la diversidad de narrativas deportiva.

Representaciones sociales de los estudiantes de la Escuela de Medicina y Ciencias de la Salud de la Universidad del Rosario sobre las Orientaciones Sexuales Diversas a la heterosexual.

El presente es un estudio de tipo exploratorio y descriptivo de corte cualitativo, que se empleó con la finalidad de conocer las representaciones sociales frente a las orientaciones sexuales diversas a la heterosexual, que tienen 35 estudiantes de la Universidad Del Rosario, sede Quinta de Mutis de los programas de Medicina, Fisioterapia y Psicología. Se realizaron 15 entrevistas individuales semiestructuradas y a profundidad, y dos grupos focales conformados por 10 estudiantes cada uno. La información fue analizada a partir del análisis de narrativas por categorías y con la ayuda del programa Atlas Ti, se organizó en las siguientes categorías generales, que permitieron abordar los objetivos de la investigación: (a) información sobre el objeto representado, (b) actitudes y creencias hacia el objeto representado, (c) prácticas discriminatorias y (d) abordaje UR, cada una de ellas contiene diversas subcategorías que ayudaron a organizar y clasificar la información recolectada. En el estudio se encontró, de acuerdo con los objetivos propuestos, que en primer lugar existe un vacío en el conocimiento acerca de las orientaciones sexuales caracterizado por la presencia de discursos estereotipados. En segundo lugar, una actitud en su mayoría indiferente frente a las personas con orientaciones sexuales diversas a la heterosexual, así como un conjunto amplio de narrativas basadas en creencias lo cual da cuenta de que los discursos nacen del conocimiento del sentido común. Por otro lado, se encuentra que existen prácticas discriminatorias directas e indirectas, así como prejuicios dentro de las narrativas. Los estudiantes perciben que en general este es un tema que no se aborda en la Universidad, llegando al consenso en que esto debería cambiar, sin embargo, las representaciones sociales que se establecen en el desconocimiento, las actitudes indiferentes y las prácticas discriminatorias, permiten ver que aún existe un discurso heteronormativo muy arraigado, que pone barreras expresadas en los prejuicios, los estereotipos y el rechazo.