Survival for rectal cancer patients has improved over the past decades. In parallel, long-term health-related quality of life (HRQoL) is gaining interest. This study focuses on the effect of ...complications following rectal cancer surgery on HRQoL and survival.
The TME-trial (1996-1999) randomized patients with operable rectal cancer between surgery with preoperative short-course radiotherapy and surgery. Questionnaires including the Rotterdam Symptom Checklist were sent at 6 time points within the first 24 months and after 14 years the EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Differences in HRQoL and survival between patients with and without complications were analyzed.
A total of 1207 patients were included, of which 482 (39.9%) patients experienced complications, surgical complications occurred in 177 (14.6%) patients, non-surgical complications in 197 (16.3%) and 108 patients (8.9%) had a combination of both types of complications. Three months after surgery, patients with a combination of surgical- and non-surgical complications, especially patients with anastomotic leakage, had the worst HRQoL. Twelve months postoperative HRQoL returned to a similar level as before surgery, regardless of complications. In patients who survived 14 years, no significant differences in HRQoL were seen between patients with and without complications. However, patients with complications did have lower overall survival.
This study shows that survival and short-term HRQoL are negatively affected by complications. Twelve months after surgery HRQoL had returned to the preoperative level regardless, of complications. Also, in patients that survived 14 years, there was no effect of complications on HRQoL detected.
This study focuses on the impact of complications after rectal cancer surgery on the short- and long-term Health-related Quality of Life (HRQoL). The results show that. short-term HRQoL was affected by complications. Twelve months postoperative HRQoL had returned to the preoperative level regardless of complications. In patients that survived 14-years, there was no effect of complications on HRQoL detected.
•Acceptance of vegetable combinations is associated with sweetness and bitterness.•Acceptance of vegetable combinations depends on mixing ratio.•Acceptance of 3/16 combinations was higher than the ...less liked vegetable.•Acceptance of the same 3/16 combinations was similar as the more liked vegetable.•For 13/16 combinations acceptance was not higher than of individual vegetables.
Enhancing sweetness of vegetables by addition of sucrose or sweeteners can increase acceptance but is not necessarily desirable. An alternative strategy could be to combine vegetables with other vegetables. By offering combinations of vegetables it might be possible to suppress bitterness, enhance sweetness and provide texture variety leading to increased acceptance. The aim of this study was to determine the influence of combining vegetables with other vegetables on sensory properties and acceptance. Carrot (sweet), cucumber (neutral), green bell pepper (bitter) and red bell pepper (sour) were assessed individually and in combination with the other three vegetables in two mixing ratios (1:2 and 2:1). Additionally, four combinations of three vegetables (mixing ratio 1:1:1) were assessed. A trained panel (n = 24) evaluated taste, flavour and texture and a consumer panel (n = 83) evaluated acceptance of all vegetables and combinations. Combining green bell pepper with carrot (1:2 and 2:1) increased sweetness and decreased bitterness. Combining cucumber, carrot or red bell pepper with green bell pepper (1:2) increased bitterness. Mainly sweetness and bitterness were associated with acceptance whereas texture (crunchiness, firmness and juiciness) did not strongly influence acceptance. Cucumber was the most accepted vegetable followed by carrot, red bell pepper and green bell pepper. Acceptance of vegetable combinations can differ from acceptance of individual vegetables depending on vegetable type and mixing ratio. Only 3 of 16 vegetable combinations had higher acceptance compared to the least accepted vegetable in the combination and similar acceptance as the more accepted vegetable in the combination. For 13 of 16 vegetable combinations acceptance did not increase compared to acceptance of individual vegetables. These findings suggest that strategies aimed at increasing vegetable consumption can be devised using specific combinations of vegetables.
The aim of the present study was to evaluate the response of surrounding tissues to newly developed poly(trimethylene carbonate) (PTMC) membranes. Furthermore, the tissue formation beneath and the ...space maintaining properties of the PTMC membrane were evaluated. Results were compared with a collagen membrane (Geistlich BioGide), which served as control. Single-sided standardized 5.0 mm circular bicortical defects were created in the mandibular angle of rats. Defects were covered with either the PTMC membrane or a collagen membrane. After 2, 4 and 12 weeks rats were sacrificed and histology was performed. The PTMC membranes induced a mild tissue reaction corresponding to a normal foreign body reaction. The PTMC membranes showed minimal cellular capsule formation and showed signs of a surface erosion process. Bone tissue formed beneath the PTMC membranes comparable to that beneath the collagen membranes. The space maintaining properties of the PTMC membranes were superior to those of the collagen membrane. Newly developed PTMC membranes can be used with success as barrier membranes in critical size rat mandibular defects.
Feather pecking and cannibalism are major concerns in poultry farming, both in terms of animal welfare and farm economics. Genetic selection and introduction of (aspects of) maternal care have been ...suggested as potential interventions to reduce feather pecking in laying hens. Altered brain development has been proposed to reflect welfare states in animals, and can provide more insight into the underlying processes involved in feather pecking. Both vasotocin (the avian homologue of vasopressin) and dopaminergic neural circuitry have roles in control of social behaviors as well as in the stress response, and may be linked to feather pecking. Thus, the hypothalamus of adult laying hens selected for low early mortality (LML), which show low feather pecking, was examined and compared with a control line of adult laying hens selected for production characteristics only (CL). The effect of foster hen rearing on the two genetic lines and their hypothalamic morphology was also investigated.
We demonstrated an increase in the number of neurons positive for the rate-limiting enzyme in dopamine production, tyrosine hydroxylase, in the periventricular area of the hypothalamus in the LML hens compared to CL hens. Hen-reared chicks showed more vasotocin -positive neurons in the medial pre-optic area compared to the hens raised without a hen. No correlations were found between behavior in an open field at 5-6 weeks of age, and the histology of the same hens at adulthood.
The hypothalamic dopaminergic and vasotinergic systems are altered in hens following genetic selection or maternal care, indicating a potential role for these systems in feather pecking.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess cardiorespiratory fitness in patients following an aneurysmal subarachnoid haemorrhage and to explore this in fatigued and non-fatigued patients.
Cross-sectional case-control study.
A total ...of 28 patients, 6 months post aneurysmal subarachnoid haemorrhage, and 28 sex- and age-matched controls.
Cardiorespiratory responses to a progressive cardiopulmonary exercise test on a cycle ergometer were obtained using indirect calorimetry. Fatigue was assessed using the Fatigue Severity Scale.
Mean peak oxygen uptake (V̇O2peak) was significantly lower in patients (22.0 (standard deviation (SD) 6.2) ml/kg/min) than in controls (69% of controls, p < 0.001). All other cardiorespiratory fitness parameters were also lower, with peak levels ranging from 62% to 77% of matched controls. Mean V̇O2peak was 19.4 (SD 4.1) ml/kg/min in fatigued patients (63% of matched controls, p < 0.001) and 23.9 (SD 6.9) ml/kg/min in non-fatigued patients (74% of matched controls, p = 0.002).
Cardiorespiratory fitness is impaired after aneurysmal subarachnoid haemorrhage, both in fatigued and non-fatigued patients. This finding may have implications for treatment.
To reduce discarding of plaice Pleuronectes platessa in the North Sea flatfish fisheries, the major nursery areas were closed to large trawlers in 1995. The area closed was named the ‘Plaice Box’ ...(PB) and beam trawl effort fell by over 90%,while the exemption fleets of small flatfish beam trawlers, gill netters targeting sole (Solea solea) and shrimp (Crangon crangon) trawlers increased their effort. Contrary to the expectation, plaice landings and biomass declined. The initial support for the PB from the fisheries was lost, whereas other stakeholder groups claimed that any failure was due to the fact that fishing had never been completely prohibited in the area. To evaluate whether the PB has been an effective management measure, the changes in the ecosystem (plaice, demersal fish, benthos) and fisheries are analyzed to test whether the observed changes are due to the PB or to changes in the environment unrelated to the PB. Juvenile growth rate of plaice decreased and juveniles moved to deeper waters outside the PB. Demersal fish biomass decreased, whereas the abundance of epibenthic predators (Asterias rubens and Cancer pagurus) increased in the PB. Endobenthos, in particular the main food items of plaice (polychaetes and small bivalves) remained stable or decreased both inside and outside the PB. Currently catches of both plaice and sole from within the PB are lower than in the late 1980s and the exemption fleet often prefers to fish outside the Plaice Box alongside much larger competitors. It is concluded that the observed changes are most likely related to changes in the North Sea ecosystem, which may be related to changes in eutrophication and temperature. It is less likely that they are related to the change in fishing. This case study highlights the importance of setting testable objectives and an appropriate evaluation framework including both ecological and socio-economic indicators when implementing closed areas.
•The history of an Marine Protected Area is discussed in the context of environmental and anthropogenic change.
Chronic subdural haematoma (CSDH) is a common neurological disease with a rapidly rising incidence due to increasing age and widespread use of anticoagulants. Surgical intervention by burr-hole ...craniotomy (BHC) is the current standard practice for symptomatic patients, but associated with complications, a recurrence rate of up to 30% and increased mortality. Dexamethasone (DXM) therapy is, therefore, used as a non-surgical alternative but considered to achieve a lower success rate. Furthermore, the benefit of DXM therapy appears much more deliberate than the immediate relief from BHC. Lack of evidence and clinical equipoise among caregivers prompts the need for a head-to-head randomised controlled trial. The objective of this study is to compare the effect of primary DXM therapy versus primary BHC on functional outcome and cost-effectiveness in symptomatic patients with CSDH.
This study is a prospective, multicentre, randomised controlled trial (RCT). Consecutive patients with a CSDH with a Markwalder Grading Scale (MGS) grade 1 to 3 will be randomised to treatment with DXM or BHC. The DXM treatment scheme will be 16 mg DXM per day (8 mg twice daily, days 1 to 4) which is then halved every 3 days until a dosage of 0.5 mg a day on day 19 and stopped on day 20. If the treatment response is insufficient (i.e. persistent or progressive symptomatology due to insufficient haematoma resolution), additional surgery can be performed. The primary outcomes are the functional outcome by means of the modified Rankin Scale (mRS) score at 3 months and cost-effectiveness at 12 months. Secondary outcomes are quality of life at 3 and 12 months using the Short Form Health Survey (SF-36) and Quality of Life after Brain Injury Overall Scale (QOLIBRI), haematoma thickness after 2 weeks on follow-up computed tomography (CT), haematoma recurrence during the first 12 months, complications and drug-related adverse events, failure of therapy within 12 months after randomisation and requiring intervention, mortality during the first 3 and 12 months, duration of hospital stay and overall healthcare and productivity costs. To test non-inferiority of DXM therapy compared to BHC, 210 patients in each treatment arm are required (assumed adjusted common odds ratio DXM compared to BHC 1.15, limit for inferiority < 0.9). The aim is to include a total of 420 patients in 3 years with an enrolment rate of 60%.
The present study should demonstrate whether treatment with DXM is as effective as BHC on functional outcome, at lower costs.
EUCTR 2015-001563-39 . Date of registration: 29 March 2015.
The presumed effectiveness of induced hypertension for treating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is based on uncontrolled case-series only. We assessed the effect of ...induced hypertension on cerebral blood flow (CBF) in aneurysmal subarachnoid hemorrhage patients with delayed cerebral ischemia in a randomized clinical trial.
Aneurysmal subarachnoid hemorrhage patients were randomized to induced or no induced hypertension (control group) at delayed cerebral ischemia onset. CBF was assessed, blinded for treatment allocation, with computed tomographic perfusion in standardized predefined regions at delayed cerebral ischemia onset and after 24 to 36 hours of study treatment. Mean arterial blood pressure was compared between groups (linear mixed model). The primary outcome measure was the difference in change in overall CBF (Mann-Whitney U test).
Mean arterial blood pressure was, on average, 12 mm Hg (95% confidence interval, 8.6-14.5) higher in the hypertension group (n=12) than in the control group (n=13). Change in overall CBF (mL/100g per s) was -8.5 (range, -42 to 30) in the control group and 0.1 (range, -31-43) in the hypertension group (P=0.25).
Change in overall CBF did not differ to a statistically significant extent between the groups. Based on our results, 225 to 250 patients per group are needed to find a statistically significant difference in change in overall CBF between induced hypertension and no hypertension.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT0161323.
As the survival of patients with rectal cancer has improved in recent decades, more and more patients have to live with the consequences of rectal cancer surgery. An influential factor in long-term ...Health-related Quality of Life (HRQoL) is the presence of a stoma. This study aimed to better understand the long-term consequences of a stoma and poor functional outcomes.
Patients who underwent curative surgery for a primary tumor located in the rectosigmoid and rectum between 2013 and 2020 were identified from the nationwide Prospective Dutch Colorectal Cancer (PLCRC) cohort study. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, and the LARS-score at 12 months, 24 months and 36 months after surgery.
A total of 1,170 patients were included of whom 751 (64.2%) had no stoma, 122 (10.4%) had a stoma at primary surgery, 45 (3.8%) had a stoma at secondary surgery and 252 (21.5%) patients that underwent abdominoperineal resection (APR). Of all patients without a stoma, 41.4% reported major low-anterior resection syndrome (LARS). Patients without a stoma reported significantly better HRQoL. Moreover, patients without a stoma significantly reported an overall better HRQoL.
The presence of a stoma and poor functional outcomes were both associated with reduced HRQoL. Patients with poor functional outcomes, defined as major LARS, reported a similar level of HRQoL compared to patients with a stoma. In addition, the HRQoL after rectal cancer surgery does not change significantly after the first year after surgery.
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