Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with ...patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care.
A comprehensive search was performed in MEDLINE, EMBASE and PsycINFO for studies between 2000 and sep-2019. Studies including adult patients (> 18 years), undergoing spinal surgery or receiving advanced cancer care, investigating patients' pre-treatment expectations regarding treatment outcomes were included. Two independent reviewers screened titles, abstracts and full-texts, extracted data and assessed methodological quality.
The search identified 7343 articles, of which 92 were selected for full-text review. For this review, 31 articles were included. Patients undergoing spinal surgery had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work. Studies highlighted that patients feel not adequately prepared for surgery in terms of post-treatment expectations. Similarly, advanced cancer patients receiving palliative treatment often had overly optimistic expectations regarding their survival probability and cure rates.
Patients tend to have overly optimistic expectations regarding pain and symptom relief, recovery and prognosis following spinal surgery or advanced cancer care. Pretreatment consultation about the expected pain and symptom relief, recovery and prognosis may improve understanding of prognosis, and promote and manage expectations, which, in turn, may lead to better perceived outcomes.
PROSPERO registration number: CRD42020145151 .
Islet cell transplantation can cure type 1 diabetes (T1D), but only a minority of recipients remains insulin-independent in the following years. We tested the hypothesis that allograft rejection and ...recurrent autoimmunity contribute to this progressive loss of islet allograft function.
Twenty-one T1D patients received cultured islet cell grafts prepared from multiple donors and transplanted under anti-thymocyte globulin (ATG) induction and tacrolimus plus mycophenolate mofetil (MMF) maintenance immunosuppression. Immunity against auto- and alloantigens was measured before and during one year after transplantation. Cellular auto- and alloreactivity was assessed by lymphocyte stimulation tests against autoantigens and cytotoxic T lymphocyte precursor assays, respectively. Humoral reactivity was measured by auto- and alloantibodies. Clinical outcome parameters--including time until insulin independence, insulin independence at one year, and C-peptide levels over one year--remained blinded until their correlation with immunological parameters. All patients showed significant improvement of metabolic control and 13 out of 21 became insulin-independent. Multivariate analyses showed that presence of cellular autoimmunity before and after transplantation is associated with delayed insulin-independence (p = 0.001 and p = 0.01, respectively) and lower circulating C-peptide levels during the first year after transplantation (p = 0.002 and p = 0.02, respectively). Seven out of eight patients without pre-existent T-cell autoreactivity became insulin-independent, versus none of the four patients reactive to both islet autoantigens GAD and IA-2 before transplantation. Autoantibody levels and cellular alloreactivity had no significant association with outcome.
In this cohort study, cellular islet-specific autoimmunity associates with clinical outcome of islet cell transplantation under ATG-tacrolimus-MMF immunosuppression. Tailored immunotherapy targeting cellular islet autoreactivity may be required. Monitoring cellular immune reactivity can be useful to identify factors influencing graft survival and to assess efficacy of immunosuppression.
Clinicaltrials.gov NCT00623610.
► Solvent resistant nanofiltration membranes from α-alumina/poly(dimethylsiloxane). ► Ceramic support of high mechanical/chemical stability combined with PDMS separation properties. ► Membrane has ...toluene flux of 1.6
±
0.1
l
m
−2
h
−1
bar
−1 and MWCO
=
500
Da in toluene.
Solvent resistant nanofiltration (SRNF) is a membrane separation process allowing for an efficient separation of small molecules of 200–1000
g
mol
−1 from organic solvents. The application of SRNF in industry applications is currently hindered by a limited choice of SRNF membranes and configurations. Despite clear advantages of capillary membranes (high surface to volume ratio, no spacers required and therefore more compact and simpler modules can be built), commercial SRNF membranes are almost exclusively produced in a spiral wound form. In this work, we prepare and study SRNF composite capillary membranes made of an α-alumina support and a selective poly (dimethylsiloxane) (PDMS) top layer. We combine the advantages of a ceramic support such as high mechanical, thermal and chemical stability with very good separation properties of the PDMS coating. All composite membranes are systematically investigated including: permeation experiments (permeance/molecular weight cut-off, MWCO) using a high pressure set-up and study of morphology using SEM imaging. The prepared composite capillary membranes are stable for at least 40
h in toluene and have MWCO of 500
Da.
Islet or β cell transplantation provides a promising cure for type 1 diabetes patients, but insulin-independency decreases frequently over time. Immunosuppressive regimens are implemented attempting ...to cope with both auto- and alloimmunity after transplantation. We analysed the influence of different immunotherapies on autoreactive and alloreactive T cell patterns and transplant outcome. Patients receiving three different immunosuppressive regimens were analysed. All patients received anti-thymocyte globulin induction therapy. Twenty-one patients received tacrolimus-mycophenolate mofetil maintenance immunosuppression, whereas the other patients received tacrolimus-sirolimus (SIR, n = 5) or SIR only (n = 5). Cellular autoreactivity and alloreactivity (CTL precursor frequency) were measured ex vivo. Clinical outcome in the first 6 months after transplantation was correlated with immunological parameters. C-peptide levels were significantly different between the three groups studied (P = 0·01). We confirm that C-peptide production was correlated negatively with pretransplant cellular autoreactivity and low graft size (P = 0·001, P = 0·007 respectively). Combining all three therapies, cellular autoimmunity after transplantation was not associated with delayed insulin-independence or C-peptide production. In combined tacrolimus-SIR and SIR-treated patients, CTL alloreactivity was associated with less insulin independence and C-peptide production (P = 0·03). The percentage of donors to whom high CTLp frequencies were measured was lower in insulin-independent recipients (P = 0·03). In this cohort of islet cell graft recipients, clinical outcome in the first 6 months after transplantation correlates with the applied immunosuppressive regimen. An association exists between insulin-independence and lower incidence of CTL alloreactivity towards donor human leucocyte antigen. This observational study demonstrates the usefulness of monitoring T cell reactivity against islet allografts to correlate immune function with graft survival.
Systemic immune cell dynamics during coronavirus disease 2019 (COVID-19) are extensively documented, but these are less well studied in the (upper) respiratory tract, where severe acute respiratory ...syndrome coronavirus 2 (SARS-CoV-2) replicates
. Here, we characterized nasal and systemic immune cells in individuals with COVID-19 who were hospitalized or convalescent and compared the immune cells to those seen in healthy donors. We observed increased nasal granulocytes, monocytes, CD11c
natural killer (NK) cells and CD4
T effector cells during acute COVID-19. The mucosal proinflammatory populations positively associated with peripheral blood human leukocyte antigen (HLA)-DR
monocytes, CD38
PD1
CD4
T effector (T
) cells and plasmablasts. However, there was no general lymphopenia in nasal mucosa, unlike in peripheral blood. Moreover, nasal neutrophils negatively associated with oxygen saturation levels in blood. Following convalescence, nasal immune cells mostly normalized, except for CD127
granulocytes and CD38
CD8
tissue-resident memory T cells (T
). SARS-CoV-2-specific CD8
T cells persisted at least 2 months after viral clearance in the nasal mucosa, indicating that COVID-19 has both transient and long-term effects on upper respiratory tract immune responses.
During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral ...artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking.
The TAVI XS trial is a multicentre, randomised, open-label clinical trial with blinded evaluation of endpoints. A total of 238 patients undergoing transfemoral TAVI will be included. The primary endpoint is the incidence of clinically relevant bleeding (i.e. Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding) of the randomised secondary access site (either diagnostic or pacemaker access, or both) within 30 days after TAVI. Secondary endpoints include time to mobilisation after TAVI, duration of hospitalisation, any BARC type 2, 3 or 5 bleeding, and early safety at 30 days according to Valve Academic Research Consortium‑3 criteria.
The TAVI XS trial is the first randomised trial comparing an upper extremity approach to a lower extremity approach with regard to clinically relevant secondary access site-related bleeding complications. The results of this trial will provide important insights into the safety and efficacy of an upper extremity approach in patients undergoing transfemoral TAVI.
Introduction: Decreasing the radiation dose in the surgical area is important to lower the risk of wound complications when surgery and radiotherapy are combined for the treatment of spinal ...metastases. The purpose of this study was to compare the radiation dose in the surgical area for spinal metastases between single fraction external beam radiotherapy (EBRT), single fraction stereotactic body radiotherapy (SBRT) and single fraction SBRT with active sparing (SBRT-AS) of the posterior surgical area.
Methods: Radiotherapy treatment plans for EBRT, SBRT and SBRT-AS of the posterior surgical area were created for 13 patients with spinal metastases. A single fraction of 8Gy was prescribed to the spinal metastasis in the EBRT plan. For the SBRT treatment plans, a single fraction of 18Gy was prescribed to the metastasis and 8Gy to the rest of the vertebral body. For the SBRT plan with active sparing the dose in the designated surgical area was minimized without compromising the dose to the organs at risk.
Results: The median dose in the surgical area was 2.6Gy (1.6-5.3Gy) in the SBRT plan with active sparing of the surgical area compared to a median dose of 3.7Gy (1.6-6.3Gy) in the SBRT plan without sparing and 6.5Gy (3.5-9.1Gy) in the EBRT plans (p < .001). The radiation doses to the spinal metastases and organs at risk were not significantly different between the SBRT plan with and without sparing the surgical area.
Conclusions: The radiation dose to the surgical area is significantly decreased with the use of SBRT compared to EBRT. Active sparing of the surgical area further decreased the mean radiation dose in the surgical area without compromising the dose to the spinal metastasis and the organs at risk.
A unique feature of Plutos large satellite Charon is its dark red northern polar cap. Similar colours on Plutos surface have been attributed to tholin-like organic macromolecules produced by ...energetic radiation processing of hydrocarbons. The polar location on Charon implicates the temperature extremes that result from Charons high obliquity and long seasons in the production of this material. The escape of Pluto's atmosphere provides a potential feedstock for a complex chemistry. Gas from Pluto that is transiently cold-trapped and processed at Charon's winter pole was proposed as an explanation for the dark coloration on the basis of an image of Charon's northern hemisphere, but not modelled quantitatively. Here we report images of the southern hemisphere illuminated by Pluto-shine and also images taken during the approach phase that show the northern polar cap over a range of longitudes. We model the surface thermal environment on Charon and the supply and temporary cold-trapping of material escaping from Pluto, as well as the photolytic processing of this material into more complex and less volatile molecules while cold-trapped. The model results are consistent with the proposed mechanism for producing the observed colour pattern on Charon.
The Alice ultraviolet spectrograph onboard the New Horizons spacecraft observed two occultations of the bright star χ Ophiucus by Jupiter’s atmosphere on February 22 and 23, 2007 during the approach ...phase of the Jupiter flyby. The ingress occultation probed the atmosphere at 32°N latitude near the dawn terminator, while egress probed 18°N latitude near the dusk terminator. A detailed analysis of both the ingress and egress occultations, including the effects of molecular hydrogen, methane, acetylene, ethylene, and ethane absorptions in the far ultraviolet (FUV), constrains the eddy diffusion coefficient at the homopause level to be
3.4
-
2.8
+
9.0
×
10
6
cm
2
s
−1, consistent with Voyager measurements and other analyses (Festou, M.C., Atreya, S.K., Donahue, T.M., Sandel, B.R., Shemansky, D.E., Broadfoot, A.L. 1981. J. Geophys. Res. 86, 5717–5725; Vervack Jr., R.J., Sandel, B.R., Gladstone, G.R., McConnell, J.C., Parkinson, C.D. 1995. Icarus 114, 163–173; Yelle, R.V., Young, L.A., Vervack Jr., R.J., Young, R., Pfister, L., Sandel, B.R. 1996. J. Geophys. Res. 101 (E1), 2149–2162). However, the actual derived pressure level of the methane homopause for both occultations differs from that derived by
Festou et al. (1981) and Yelle et al. (1996) from the Voyager ultraviolet occultations, suggesting possible changes in the strength of atmospheric mixing with time. We find that at 32°N latitude, the methane concentration is
3.1
-
0.5
+
0.5
×
10
8
cm
−3 at 70,397
km, the methane concentration is
1.2
-
0.3
+
0.3
×
10
9
cm
−3 at 70,383
km, the acetylene concentration is
1.4
-
0.2
+
0.4
×
10
8
cm
−3 at 70,364
km, and the ethane concentration is
6.8
-
0.8
+
1.1
×
10
8
cm
−3 at 70,360
km. At 18°N latitude, the methane concentration is
3.2
-
0.7
+
0.7
×
10
8
cm
−3 at 71,345
km, the methane concentration is
1.2
-
0.2
+
0.6
×
10
9
cm
−3 at 71,332
km, the acetylene concentration is
1.6
-
0.6
+
0.3
×
10
8
cm
−3 at 71,318
km, and the ethane concentration is
7.0
-
2.5
+
2.4
×
10
8
cm
−3 at 71,315
km. We also find that the H
2 occultation light curve is best reproduced if the atmosphere remains cold in the microbar region such that the base of the thermosphere is located at a lower pressure level than that determined by
in situ instruments aboard the Galileo probe (Seiff, A., Kirk, D.B., Knight, T.C.D., Young, R.E., Mihalov, J.D., Young, L.A., Milos, F.S., Schubert, G., Blanchard, R.C., Atkinson, D. 1998. J. Geophys. Res. 103 (E10), 22857–22889) – the Sieff et al. temperature profile leads to too much absorption from H
2 at high altitudes. However, this result is highly model dependent and non-unique. The observations and analysis help constrain photochemical models of Jupiter’s atmosphere.
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