Reply to commentary by R Duggleby (2019) Steele, Edward J.; Al-Mufti, Shirwan; Augustyn, Kenneth A. ...
Progress in biophysics and molecular biology,
January 2019, 2019-01-00, 20190101, Letnik:
141
Journal Article
This longitudinal study evaluated the effectiveness of a multi-disciplinary community-based service offering conservative treatment for Australian women suffering urinary incontinence and living ...independently in the community, in terms ofurinary incontinence symptom severity, impact on quality of life and knowledge outcomes. One hundred and twenty-three women attending The Waterworx Centre, a multi-disciplinary, publicly funded community-based continence service in South East Queensland Australia participated in the study. They received multi-disciplinary conservative treatment for urinary incontinence, including comprehensive assessment and an individually-tailored plan of care. All the women were also linked back to their own generalist health professional for ongoing care and management.
Data were collected over a one-year period: at first consultation, and at three months and six months following the first consultation. The International Continence Society Urinary Symptom Index Short Form-Female was used to measure urinary symptoms and impact on quality of life, and a researcher-developed test was used to measure changes in knowledge.
Results showed that the women experienced an improvement in urinary symptoms and continence-related knowledge at three months following first consultation, and a decreased impact on quality of life, with these improvements either being sustained or increasing at six months. This study demonstrated that multi-disciplinary community-based services offering specialist conservative treatment for women suffering urinary incontinence can be effective in achieving improvements in urinary symptoms and continence-related knowledge and reducing the impact of urinary incontinence on quality of life.
Management of screen-detected ductal carcinoma in situ (DCIS) remains controversial.
A prospective cohort of patients with DCIS diagnosed through the UK National Health Service Breast Screening ...Programme (1st April 2003 to 31st March 2012) was linked to national databases and case note review to analyse patterns of care, recurrence and mortality.
Screen-detected DCIS in 9938 women, with mean age of 60 years (range 46–87), was treated by mastectomy (2931) or breast conserving surgery (BCS) (7007; 70%). At 64 months median follow-up, 697 (6.8%) had further DCIS or invasive breast cancer after BCS (7.8%) or mastectomy (4.5%) (p < 0.001). Breast radiotherapy (RT) after BCS (4363/7007; 62.3%) was associated with a 3.1% absolute reduction in ipsilateral recurrent DCIS or invasive breast cancer (no RT: 7.2% versus RT: 4.1% p < 0.001) and a 1.9% absolute reduction for ipsilateral invasive breast recurrence (no RT: 3.8% versus RT: 1.9% p < 0.001), independent of the excision margin width or size of DCIS. Women without RT after BCS had more ipsilateral breast recurrences (p < 0.001) when the radial excision margin was <2 mm. Adjuvant endocrine therapy (1208/9938; 12%) was associated with a reduction in any ipsilateral recurrence, whether RT was received (hazard ratio HR 0.57; 95% confidence interval CI 0.41–0.80) or not (HR 0.68; 95% CI 0.51–0.91) after BCS. Women who developed invasive breast recurrence had a worse survival than those with recurrent DCIS (p < 0.001). Among 321 (3.2%) who died, only 46 deaths were attributed to invasive breast cancer.
Recurrent DCIS or invasive cancer is uncommon after screen-detected DCIS. Both RT and endocrine therapy were associated with a reduction in further events but not with breast cancer mortality within 5 years of diagnosis. Further research to identify biomarkers of recurrence risk, particularly as invasive disease, is indicated.
•Adjuvant radiotherapy (RT) after wide excision is associated with a reduced risk of ipsilateral recurrence but not mortality•Survival after treatment of DCIS is excellent, with few subsequent deaths from breast cancer.•Further DCIS or invasive breast cancer is not uncommon (6.8% at 5 years)•5-year mortality was not impacted by the use of RT or endocrine therapy.
A silica-bound C-butylpyrogallol4arene chromatographic stationary phase was prepared and characterised by thermogravimetric analysis, scanning electron microscopy, NMR and mass spectrometry. The ...chromatographic performance was investigated by using C60 and C70 fullerenes in reverse phase mode via flash column and high-pressure liquid chromatography (HPLC). The resulting new stationary phase was observed to demonstrate size-selective molecular recognition as postulated from our in-silico studies. The silica-bound C-butylpyrogallol4arene flash and HPLC stationary phases were able to separate a C60- and C70-fullerene mixture more effectively than an RP-C18 stationary phase. The presence of toluene in the mobile phase plays a significant role in achieving symmetrical peaks in flash column chromatography.
Purpose Care of children with spina bifida has significantly advanced in the last half century, resulting in gains in longevity and quality of life for affected children and caregivers. Bladder ...dysfunction is the norm in patients with spina bifida and may result in infection, renal scarring and chronic kidney disease. However, the optimal urological management for spina bifida related bladder dysfunction is unknown. Materials and Methods In 2012 the Centers for Disease Control and Prevention convened a working group composed of pediatric urologists, nephrologists, epidemiologists, methodologists, community advocates and Centers for Disease Control and Prevention personnel to develop a protocol to optimize urological care of children with spina bifida from the newborn period through age 5 years. Results An iterative quality improvement protocol was selected. In this model participating institutions agree to prospectively treat all newborns with spina bifida using a single consensus based protocol. During the 5-year study period outcomes will be routinely assessed and the protocol adjusted as needed to optimize patient and process outcomes. Primary study outcomes include urinary tract infections, renal scarring, renal function and bladder characteristics. The protocol specifies the timing and use of testing (eg ultrasonography, urodynamics) and interventions (eg intermittent catheterization, prophylactic antibiotics, antimuscarinic medications). Starting in 2014 the Centers for Disease Control and Prevention began funding 9 study sites to implement and evaluate the protocol. Conclusions The Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida began accruing patients in 2015. Assessment in the first 5 years will focus on urinary tract infections, renal function, renal scarring and clinical process improvements.
A new time-of-flight (TOF) mass spectrometer incorporating post-ionization of sputtered neutral species with tunable vacuum ultraviolet (VUV) light generated by a free electron laser (FEL) has been ...developed. Capabilities of this instrument, called SPIRIT, were demonstrated by experiments with photoionization of sputtered neutral gold atoms with 125
nm light generated by the VUV FEL located at Argonne National Laboratory (ANL). In a separate series of experiments with a fixed wavelength VUV light source, a 157
nm F
2 laser, a useful yield (atoms detected per atoms sputtered) of about 12% and a mass resolution better than 1500 were demonstrated for molybdenum.
Circulating tumour DNA analysis can be used to track tumour burden and analyse cancer genomes non-invasively but the extent to which it represents metastatic heterogeneity is unknown. Here we follow ...a patient with metastatic ER-positive and HER2-positive breast cancer receiving two lines of targeted therapy over 3 years. We characterize genomic architecture and infer clonal evolution in eight tumour biopsies and nine plasma samples collected over 1,193 days of clinical follow-up using exome and targeted amplicon sequencing. Mutation levels in the plasma samples reflect the clonal hierarchy inferred from sequencing of tumour biopsies. Serial changes in circulating levels of sub-clonal private mutations correlate with different treatment responses between metastatic sites. This comparison of biopsy and plasma samples in a single patient with metastatic breast cancer shows that circulating tumour DNA can allow real-time sampling of multifocal clonal evolution.
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