•IGE patients performed worse in neurocognitive profile than healthy controls.•Siblings of IGE performed worse in neurocognitive profile than healthy controls.•IGE and their biological siblings had ...the most impaired performance in executive functions.
Idiopathic generalized epilepsy (IGE) is one of the most common epilepsies and is believed to have a strong genetic origin. Patients with IGE present largely heterogeneous neurocognitive profiles and might show some neurocognitive impairments. Furthermore, IGE siblings may demonstrate worse results in neuropsychological tests as well. In our study, we aimed to map the neurocognitive profile both in patients with IGE and the siblings. We also sought to establish a neurocognitive profile for each IGE syndrome.
The research sample included 110 subjects (IGE n = 46, biological siblings BS n = 16, and healthy controls n = 48) examined. Subjects were neuropsychologically examined in domains of intelligence, attention, memory, executive, and motor functions. The data obtained from the examination were statistically processed to determine whether and how IGE patients (including distinct syndromes) and the siblings differed neurocognitively from healthy controls (adjusted z–scores by age, education, and gender, and composite z-scores of cognitive domains). Data on anti-seizure medication, including defined daily doses, were obtained and included in the analysis.
IGE patients and their biological siblings performed significantly worse in most of the neuropsychological tests than healthy controls. The neurocognitive profile of composite z-scores showed that IGE and biological siblings had equally significantly impaired performance in executive functions. IGE group also demonstrated impaired composite attention and motor function scores. The profile of individual IGE syndromes showed that JAE, JME, and EGTCS had significantly worse performance in composite execution score and motor function score. JAE presented significantly worse performance in intelligence and attention. JME exhibited significantly worse composite score in the attention domain. Anti-seizure medication, depression, and quality of life were unrelated to cognitive performance in IGE group. The level of depression significantly predicted the overall value of quality of life in patients with IGE, while cognitive domains, sociodemographic, and clinical factors were unrelated.
Our study highlights the importance to consider the neurocognitive profile of IGE patients that can lead to difficulties in their education, acceptance, and management of coping strategies. Cognitive difficulties of IGE siblings could support a hypothesis that these impairments emerge from heritable traits.
Respondents’ perception about the possible changes of best before date (BBD) to the date of the highest quality was the main aim of the survey. The survey consisted out of 1,107 respondents who were ...grouped according to their demographic characteristics and food labelling preferences. The results of the survey are indicating high acceptance rate towards new labelling, but without clear connection with their preferences. Another aspect of the research emphasised the respondents’ perception towards the price of healthier food commodities and revealed that education level has high impact ( P < 0.05) on their opinion and considerations. The survey gave important answers on possibility of changes of food labelling by which it would be affected food waste quantities. Certainly, each food type shelf life should be checked and labelled according to food perishability and consumers safeness. The changing of the BBD to the date of the highest quality according to our survey would be broadly accepted among all socio-demographic groups.
Stagnant water bodies have generally received little attention regarding the presence of endocrine disruptive compounds, although they can integrate diverse pollutants from multiple different ...sources. Many compounds of anthropogenic as well as natural origin can contribute to the overall estrogenicity of surface waters and some of them can exhibit adverse effects on aquatic biota even in very low concentrations. This study focused on freshwater ponds and reservoirs affected by water blooms and determined the estrogenic activity of water by in vitro bioassay as well as concentrations of several important groups of estrogenic compounds (estrogenic hormones, alkylphenols, and phytoestrogens) by LC-MS/MS analyses. Estrogenic hormones were found at concentrations up to 7.1 ng.L−1, similarly to flavonoids, whose concentrations did not exceed 12.5 ng.L−1. Among alkylphenols, only bisphenol A and 4-tert-octylphenol were detected in levels reaching 100 ng.L−1 at maximum. Estrogenic activity of water samples varied from below the quantification limit to 1.95 ng.L−1. There does not seem to be any general causal link of the massive phytoplankton occurrence with the estrogenicity of water or concentration of phytoestrogens, since they showed no direct relationship with the phytoplankton abundance or composition across sites. The contribution of the analysed compounds to the estrogenic activity was calculated in three scenarios. In minimum scenario, just the compounds above quantification limit (LOQ) were taken into account and for most samples, only minor part (<6%) of the biological activity could be explained. In the mean and maximum scenarios, we included also compounds below LOQ into the calculations at the level of LOQ/2 and LOQ, respectively. In these cases, a considerable part of the estrogenic activity could be attributed to the possible presence of steroid estrogens below LOQ. However, for the samples with estrogenic activity greater than 1 ng.L−1, more than 50% of the estrogenic activity remained unexplained even in the maximum scenario. Probably other compounds or possible interactions between individual substances cause the estrogenic activity in these types of water bodies and in this case, the results of LC-MS/MS analyses cannot sufficiently predict the biological effects. A complex approach including bioassays is needed when assessing the estrogenicity of these types of surface waters.
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•Anthropogenic and natural estrogens co-occur at ng.L−1 levels in stagnant waters.•Estrogenic activity of stagnant waters up to 2 ng.L−1 of estrogen equivalent.•More than 50% of estrogenic activity of the most active samples unexplained.•Some compounds can significantly contribute even below quantification limit.•No direct relation of estrogenicity or estrogens with phytoplankton occurrence.
In cervical cancer, presence of lymph-node macrometastases (MAC) is a major prognostic factor and an indication for adjuvant treatment. However, since clinical impact of micrometastases (MIC) and ...isolated tumor-cells (ITC) remains controversial, we sought to identify a cut-off value for the metastasis size not associated with negative prognosis.
We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveillance in Cervical CANcer) database, who underwent primary surgical treatment, including sentinel lymph-node (SLN) biopsy with pathological ultrastaging. The size of SLN metastasis was considered a continuous variable and multiple testing was performed for cut-off values of 0.01–1.0 mm. Disease-free survival (DFS) was compared between N0 and subgroups of N1 patients defined by cut-off ranges.
LN metastases were found in 172 (18%) patients, classified as MAC, MIC, and ITC in 79, 54, and 39 patients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS compared to N0 in all subgroups with metastases ≥0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group.
In cervical cancer patients, the presence of LN metastases ≥0.4 mm was associated with a significant negative impact on DFS and no cut-off value for the size of metastasis with better prognosis than N1 was found. Traditional metastasis stratification based on size has no clinical implication.
•Classification of metastases to MAC, MIC and ITC is of no clinical value in cervical cancer.•DFS did not differ between patients with MAC or MIC and was shorter than in N0.•DFS was significantly shorter in patients with metastases ≥0.4 mm compared to N0.•No subcohort with better prognosis than the rest of the N1 cohort was identified.•LN metastases have a significant negative impact on DFS regardless of the size.
The aim of this study was evaluated the effect of selected bioactive substances and nanoparticles on the immunoreactivity of edible packages based on chitosan using the ELISA. The analysed protein ...was the tropomyosin. The results confirmed the presence of the tropomyosin (3.77 ± 0.79-5.75 ± 0.01 µg/g) in control samples. This study demonstrated that the bioactive substances in the form of grape (0.61 ± 0.34-0.43 ± 0.16 µg/g), blueberry (0.58 ± 0.32-0.39 ± 0.27 µg/g), and parsley extracts (2.09 ± 1.28-0.79 ± 0.40 µg/g) reduces immunoreactivity (p < 0.05) of the tropomyosin. The elder pollen had no significant effect (p > 0.05) on immunoreactivity. ZnO and TiO
2
nanoparticles also demonstrated immunoreactivity reduction (p < 0.05). The exception was silver nanoparticles, where the immunoreactivity increased with increasing concentration of grape extract (1.29 ± 0.01-5.47 ± 0.25 µg/g). The results confirmed the inhibitory effect of bioactive substances on the immunoreactivity of the used ELISA and also showed the need to consider immunoreactive substances when interpreting ELISA results.
International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer.
This study aimed to ...assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence.
This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non–nerve-sparing radical hysterectomy.
A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non–nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non–nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P<.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non–nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P=.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non–nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9–92.2) vs 93.8% (95% confidence interval, 91.1–96.5), respectively (P=.047). Non–nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31–0.81; P=.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non–nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1–97.2) vs non–nerve-sparing 96.5% (95% confidence interval, 94.3–98.7), respectively (P=.78). In patients with a tumor diameter ≤20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non–nerve-sparing radical hysterectomy (P=.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non–nerve-sparing radical hysterectomy vs 83.1% in nerve-sparing radical hysterectomy (P=.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P=.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P=.70).
For tumors ≤20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease-free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non–nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve-sparing radical hysterectomy after propensity score match analysis.
Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for ...individualised surveillance based on a patient's risk profile.
Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated.
Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five.
The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally.
•The recurrence risk model in cervical cancer was composed of five prognostic factors.•The developed annual recurrence risk model (ARRM) stratifies the cohort into five significantly distinctive risk groups.•The ARRM represents a powerful tool for tailoring of appropriate surveillance strategy.•The ARRM can easily be used in routine clinical settings internationally.
To evaluate the association of number of radical hysterectomies performed per year in each center with disease-free survival and overall survival.
We conducted an international, multicenter, ...retrospective study of patients previously included in the Surveillance in Cervical Cancer collaborative studies. Individuals with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIA1 cervical cancer who underwent radical hysterectomy and had negative lymph nodes at final histology were included. Patients were treated at referral centers for gynecologic oncology according to updated national and international guidelines. Optimal cutoffs for surgical volume were identified using an unadjusted Cox proportional hazard model, with disease-free survival as the outcome and defined as the value that minimizes the P-value of the split in groups in terms of disease-free survival. Propensity score matching was used to create statistically similar cohorts at baseline.
A total of 2,157 patients were initially included. The two most significant cutoffs for surgical volume were identified at seven and 17 surgical procedures, dividing the entire cohort into low-volume, middle-volume, and high-volume centers. After propensity score matching, 1,238 patients were analyzed-619 (50.0%) in the high-volume group, 523 (42.2%) in the middle-volume group, and 96 (7.8%) in the low-volume group. Patients who underwent surgery in higher-volume institutions had progressively better 5-year disease-free survival than those who underwent surgery in lower-volume centers (92.3% vs 88.9% vs 83.8%, P=.029). No difference was noted in 5-year overall survival (95.9% vs 97.2% vs 95.2%, P=.70). Cox multivariable regression analysis showed that FIGO stage greater than IB1, presence of lymphovascular space invasion, grade greater than 1, tumor diameter greater than 20 mm, minimally invasive surgical approach, nonsquamous cell carcinoma histology, and lower-volume centers represented independent risk factors for recurrence.
Surgical volume of centers represented an independent prognostic factor affecting disease-free survival. Increasing number of radical hysterectomies performed in each center every year was associated with improved disease-free survival.
Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. ...Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS.
Data from 528 patients with early-stage cervical cancer who relapsed after primary surgery performed between 2007 and 2016 were obtained from the SCANN study (Surveillance in Cervical CANcer). Factors related to the primary disease and recurrence were combined in a multivariable Cox proportional hazards model to predict PR-DSS.
The 5-year PR-DSS was 39.1% (95% confidence interval CI 22.7%–44.5%), median disease-free interval between primary surgery and recurrence (DFI1) was 1.5 years, and median survival after recurrence was 2.5 years. Six significant variables were identified in the multivariable analysis and were used to construct the prognostic model. Two were related to primary treatment (largest tumour size and lymphovascular space invasion) and four to recurrence (DFI1, age at recurrence, presence of symptoms, and recurrence type). The C-statistic after 10-fold cross-validation of prognostic model reached 0.701 (95% CI 0.675–0.727). Three risk-groups with significantly differing prognoses were identified, with 5-year PR-DSS rates of 81.8%, 44.6%, and 12.7%.
We developed the robust model of PR-DSS to stratify patients with relapsed cervical cancer according to risk profiles using six routinely recorded prognostic markers. The model can be utilised in clinical practice to aid decision-making on the strategy of recurrence management, and to better inform the patients.
•The 5-year post-recurrence disease-specific survival (PR-DSS) rate was 39.1% in patients with early-stage cervical cancer.•The strongest factors for PR-DSS were primary tumour size and the presence of symptoms at diagnosis of recurrence.•The presence of symptoms at recurrence remained a significant prognostic factor after correction for lead-time bias.•PR-DSS was best in patients without LN involvement or LVSI suffering from solitary asymptomatic recurrence.
This study aimed to determine the degree of depression and anxiety in cancer patients using the Emotion Thermometers (ET) and confirming their clinical usefulness compared to the gold standard ...interview, as well as determining optimal cut-off values for the appropriate identification of cancer patients' distress.
We included 238 cancer patients and we used ET (Emotion Thermometers) to screen depression and anxiety and the Beck depression inventory for adults (BDI-II), the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Mini-International Neuropsychiatric Interview (M.I.N.I) was used as the criterial validity standard.
The prevalence of anxiety on the M.I.N.I. was 24% and depression was 11%. The optimal value for diagnosis of depression from ET (Dep ET) appears to be > 4.5 (AUC 0.928) against M.I.N.I. Optimal score for anxiety from ET (AnxT ET) compared to GAD according to M.I.N.I. we determined the value of 3.5 (AUC 0.899). To determine the cut off score for distress using from ET (DT), we compared against GAD-7 and BDI-II RS (raw total score) and the most optimal was 4.5 (AUC 0.953). For analysis of the cut off score for quality of life (QoL) against the total sums of all parts of the ET, the value of 14.5 (AUC 0.892) forms the cut off between the negative and the positive clinical finding.
The results of the study support the use of ET as a rapid screening tool for the detection of depression, anxiety and distress in cancer patients.
•Depression leads to a deterioration in quality of life, negatively affects treatment outcomes and even contributes to a higher mortality rate in cancer patients.•The inclusion of a psychological approach in complex oncology care should be a great contribution.•The aim of the study was to determine the degree of depression and anxiety in a group of cancer patients and to point out the necessity for screening of these disorders.•Our research confirmed relatively high levels of depression and anxiety in cancer patients.•Emotion Thermometers (ET) seems to be an effective way to provide oncologists the opportunity to screen for depression and anxiety.
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