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To evaluate the prognostic value of sequential dual-phase CBCT (DP-CBCT) imaging performed during degradable starch microsphere TACE (DSM-TACE) session in predicting the HCC’s response to treatment, evaluate with modify response evaluation criteria in solid tumours (mRECIST) at 1-month multi-detector CT (MDCT) follow-up. Between January and May 2018, 24 patients (68.5 ± 8.5 year [45–85]) with HCC lesions (n = 96 [average 4/patient]) were prospectively enrolled. Imaging assessment included: pre-procedural MDCT, intra-procedural DP-CBCT performed before first and second DSM-TACEs and 1-month follow-up MDCT. Lesions’ attenuation/pseudo-attenuation was defined as average value measured on ROIs (HU for MDCT; arbitrary unit called HU* for CBCT). Lesions’ attenuation modification was correlated with the post-procedural mRECIST criteria at 1-month MDCT. Eighty-two DSM-TACEs were performed. Lesion’s attenuation values were: pre-procedural MDCT arterial phase (AP) 107.00 HU (CI 95% 100.00–115.49), venous phase (VP) 85.00 HU (CI 95% 81.13–91.74); and lesion’s pseudo-attenuation were: first CBCT-AP 305.00 HU* (CI 95% 259.77–354.04), CBCT-VP 155.00 HU* (CI 95% 135.00–163.34). For second CBCT were: -AP 210.00 HU* (CI 95% 179.47–228.58), -VP 141.00 HU* (CI 95% 125.47–158.11); and for post-procedural MDCT were: -AP 95.00 HU (CI 95% 81.35–102.00), -VP 83.00 HU (CI 95% 78.00–88.00). ROC curve analysis showed that a higher difference pseudo-attenuation between first and second DP-CBCTs is related to treatment response. The optimal cut-off value of the difference between first and second CBCT-APs to predict complete response, objective response (complete + partial response) and overall disease control (objective response + stable disease) were > 206 HU* (sensitivity 80.0%, specificity 81.7%), > 72 HU* (sensitivity 79.5%, specificity 83.0%) and > − 7 HU* (sensitivity 91.6%, specificity 65.4%), respectively. DP-CBCT can predict intra-procedurally, by assessing lesion pseudo-attenuation modification, the DSM-TACE 1-month treatment outcome.

BACKGROUND: Many factors affect survival in haemodialysis (HD) patients. Our aim was to study whether quality of clinical care may affect survival in this population, when adjusted for demographic characteristics and co-morbidities. METHODS: We studied survival in 553 patients treated by chronic HD during March 2001 in 21 dialysis facilities in western Switzerland. Indicators of quality of care were established for anaemia control, calcium and phosphate product, serum albumin, pre-dialysis blood pressure (BP), type of vascular access and dialysis adequacy (spKt/V) and their baseline values were related to 3-year survival. The modified Charlson co-morbidity index (including age) and transplantation status were also considered as a predictor of survival. RESULTS: Three-year survival was obtained for 96% of the patients; 39% (211/541) of these patients had died. The 3-year survival was 50, 62 and 69%, respectively, in patients who had 0-2, 3 and >or=4 fulfilled indicators of quality of care (test for linear trend, P < 0.001). In a Cox multivariate analysis model, the absence of transplantation, a higher modified Charlson's score, decreased fulfilment of indicators of good clinical care and low pre-dialysis systolic BP were independent predictors of death. CONCLUSION: Good clinical care improves survival in HD patients, even after adjustment for availability of transplantation and co-morbidities.

Background and aims Whether Fibroscan thresholds can be immediately adopted for none, some or all other shear wave elastography techniques has not been tested. The aim of the present study was to test the concordance of the findings obtained from 7 of the most recent ultrasound elastography machines with respect to Fibroscan. Methods Sixteen hepatitis C virus-related patients with fibrosis ≥2 and having reliable results at Fibroscan were investigated in two intercostal spaces using 7 different elastography machines. Coefficients of both precision (an index of data dispersion) and accuracy (an index of bias correction factors expressing different magnitudes of changes in comparison to the reference) were calculated. Results Median stiffness values differed among the different machines as did coefficients of both precision (range 0.54–0.72) and accuracy (range 0.28–0.87). When the average of the measurements of two intercostal spaces was considered, coefficients of precision significantly increased with all machines (range 0.72–0.90) whereas of accuracy improved more scatteredly and by a smaller degree (range 0.40–0.99). Conclusions The present results showed only moderate concordance of the majority of elastography machines with the Fibroscan results, preventing the possibility of the immediate universal adoption of Fibroscan thresholds for defining liver fibrosis staging for all new machines.

Men living at high altitudes in Peru compared to sea level counterparts have erythrocytosis (hemoglobin 16-21 g/dl) or excessive erythrocytosis (hemoglobin>21 g/dl). High testosterone (T) levels in men at high altitude (HA) were associated with excessive erythrocytosis. High androgen levels could be due to a low aromatase activity or to an elevated rate of conversion from precursors to testosterone. The aim of this study was to evaluate aromatase activity and rate of conversion from precursors to testosterone before and after administration of the aromatase enzyme inhibitor letrozole (5 mg/day) for a 5-day period to men at HA and at sea level (SL). The response to short term aromatase inhibition was assessed in 30 adult men living at sea level, 31 native men at HA with erythrocytosis (Hb 16-21 g/dl), and 35 men at HA with excessive erythrocytosis (Hb>21 g/dl). Serum hormone levels, estradiol/testosterone, testosterone/androstenedione, and testosterone/dehydroepiandrosterone sulfate (DHEAS) ratios were measured. Men with erythrocytosis had lower basal serum T/androstenedione ratios than men with excessive erythrocytosis at HA and men at sea level. Men at HA with excessive erythrocytosis had higher T/DHEAS ratios than men with erythrocytosis and than those at sea level before and after letrozole administration. After letrozole administration, both groups of men at high altitude (with erythrocytosis or with excessive erythrocytosis) showed lower aromatase activities than those at sea level. In conclusion, higher serum testosterone levels in men with excessive erythrocytosis were associated with an increased rate of conversion from DHEAS to testosterone rather than to a lower aromatase activity.

The purpose of this study was to analyze in which physical capabilities boys and girls are closer or distant. An additional objective was to find which of the body fat, physical activity, and somatotype factors have a greater effect on prepubescent children's physical fitness. This was a cross-sectional study involving 312 children (10.8 ± 0.4 years). The physical fitness assessment employed sets of aerobic fitness, strength, flexibility, speed, agility, and balance. The boys presented higher values in all selected tests, except tests of balance and flexibility, in which girls scored better. Gender differences in the physical fitness were greatest in the explosive strength of upper (p ≤ 0.01, η(p)(2) = 0.09) and lower limbs (p ≤ 0.01, η(p)(2) = 0.08), although with a medium-size effect of gender, and smaller in the abdominal (p > 0.05, η(p)(2) = 0.007) and upper limbs (p > 0.05, η(p)(2) = 0.003) muscular endurance, and trunk extensor strength and flexibility (p > 0.05, η(p)(2) = 0.001). The endomorphic (p ≤ 0.01, η(p)(2) = 0.26) in the girls, and the ectomorphic (p ≤ 0.01, η(p)(2) = 0.31) and mesomorphic (p ≤ 0.01, η(p)(2) = 0.26) in the boys, had the high-sized effect on the physical fitness. The physical activity in the girls, and the endomorphic and body fat in the boys, did not have a significant effect. These findings can help in the planning of activities that take into account the success and motivation of both boys and girls and thus increase levels of physical activity and physical fitness at school. However, in prepubescent children, one cannot neglect the influence of genetic determinism, observed from the morphoconstitutional point of view.

International audience; AIM: The aim of the present study was to analyse the effects of training performed on a rotating, motorised platform (the Huber/SpineForce device from LPG Systems, Valence, France) intended to improve, postural control and muscle function.SUBJECTS: Twelve healthy adults (divided into a sedentary group and an active group) took part in a two-month training programme (involving three sessions a week) on the SpineForce whole body rehabilitation device.METHOD: Instrumental assessment of postural control (on a Satel platform) and muscle function (on a Cybex Norm) was performed before and after training. Postural control in various conditions was measured using a position parameter (the mean anteroposterior position of the centre of foot pressure [CoP]) and two stability parameters (maximum CoP displacement and CoP sway area). Assessment of the muscle function was performed during knee and spine extension and featured maximum voluntary isometric contraction (MVIC), root mean square (RMS) and neuromuscular efficiency (MVIC/RMS) measurements.RESULTS: For static postural control, we observed a more forward CoP position in the maximum backward inclination condition (p

INTRODUCTION: With 3-dimensional scanning, the image of 1 digital dental cast can be superimposed on another to observe growth or treatment changes; however, this requires stable references. The palatal rugae were considered reliable points for detecting dental changes on the cast's occlusal plane, but is this the case in the vertical plane? Our aims were to assess the long-term stability of the palatal rugae in the vertical dimension, relate them to possible maxillary incisor posteruptive movements, and validate them as references for the evaluation of longitudinal dental changes. METHODS: Four-year longitudinal lateral cephalograms and dental casts of 10 adults and 13 adolescents were used. The median palatal contour of each cast and marks corresponding to each ruga were superimposed on the palate of the cephalograms. Changes in rugae positions during the observation period were measured with respect to the palatal plane. RESULTS: Vertical changes were greater for the first rugae (closest to the incisors), less for the second, and even less for the third (farthest from the incisors). The adolescents showed greater vertical changes in rugae position than the adults. There were no statistically significant differences in the anteroposterior changes between the groups. The maxillary central incisor and the first ruga had vertical displacements proportional to the increase of the subject's lower anterior facial height. CONCLUSIONS: We found vertical displacement of the maxillary incisor and the rugae during the 4 years of observation in adolescents and adults. The third ruga, the farthest from the incisors, can be used as a reliable reference to assess longitudinal dental changes mainly when growth changes are less prominent.

The overall aim of this thesis was to evaluate stroke unit care for elderly patients, aged > 70 years, in daily life activities, health-related quality of life and costs, to describe patients´ conditions from the perspectives of re-admissions to hospital care and to identify the consequences of cognitive impairments on daily life activities and costs.I-II. Two hundred and forty-nine patients aged > 70 years with acute stroke within seven days before admission and living at home were entered consecutively into the study and randomised to two groups: 166 patients (intervention) were assigned to a non-intensive stroke unit care with a care continuum including stroke unit in geriatric wards for patients needing long rehabilitation time and 83 patients (control) were assigned to general medical wards. Outcome measures were patients at home after one year, ability in daily life activities (ADL), health-related quality of life, use of resources and costs of health care. Two registered occupational therapists not involved in the design of the study and the treatment of the patients made all evaluations of the study outcome.Sixty-one percent of the patients in the stroke unit group and 59% in the general medical ward group were at home after one year. There were no significant differences in survival rates, ability in daily life activities and health-related quality of life. The mean annual cost per patient was 170 000 Swedish crowns (SEK) and 191 000 SEK in the stroke unit and the general medical wards, respectively (not statistical significant). Seventy percent of the total cost was for in-patient care, and 30% was for outpatient care, social service and informal care. The costs varied greatly depending on the severity of the stroke. III. Two hundred and sixteen patients were discharged to their homes or to nursing homes after acute stroke. Nearly half of these patients were re-admitted to hospital care. One re-admission was most common. Stroke-related diagnoses, followed by heart disease, were most frequently reasons for re-admission. The re-admitted patients were significantly more dependent in daily life activities and reported a lower health-related quality of life as compared to patients who were not re-admitted. IV. Cognitive impairment was assessed one and a half year after acute stroke. Patients with cognitive impairment were more dependent on personal assistance in ADL. Costs per patients during the study were three times higher for patient's with cognitive impairment. Hospital care, institutional living and different kinds of support from society were associated with the highest costs.V. Evaluations were made of concordance on the item level between the assessments of ADL by the Functional Independence Measure (FIM) and Sunnaas Index of ADL. The concordance was high for many items, but operational differences were identified between some FIM and SI items. In some of the items the seven-point item scale in the FIM could be reduced to four levels without loss of information.

La Organización Mundial de la Salud considera el cambio climático o calentamiento global un problema de salud pública. De esta manera, se hace necesario conocer la percepción del riesgo al cambio climático en las diferentes comunidades para proponer acciones de adaptación y mitigación al cambio climático; pero esa percepción del riesgo puede variar en las diferentes poblaciones. El objetivo del presente trabajo fue observar la percepción de riesgo sobre el cambio climático como una amenaza para la salud humana en Taganga, Santa Marta, 2014. A nivel metodológico se encuestaron 484 personas de la comunidad de Taganga, mediante un muestreo por conglomerado. Se les aplicó el instrumento validado, a nivel internacional y nacional, mediante el alfa de Cronbach y el coeficiente de Kuder-Richardson 20. Entre los índices se aplicó la correlación de Spearman. Como resultados se observó una correlación estadísticamente significativa entre las acciones políticas frente al cambio climático y el índice de percepción de riesgo; y también entre el índice de voluntad para actuar y los índices de percepción de riesgo, conocimiento sobre los efectos en la salud por causa del cambio climático y las acciones políticas frente al cambio climático. En este estudio se concluye que existe una asociación entre el índice de voluntad para actuar y la percepción de riesgo, conocimiento sobre los efectos en la salud por el cambio climático y las acciones políticas frente al cambio climático; igualmente, una asociación entre las acciones políticas frente al cambio climático y la percepción de riesgo. The World Health Organization considers climate change or global warming a problem of public health. Thus it is necessary to know the perception of risk to climate change in different communities to generate actions for adaptation and mitigation to climate change; but that perception of risk may vary in different populations. The objective of this study was to observe the risk perception on climate change as a threat to human health in the town of Taganga, Santa Marta, 2014. In methods, it was surveyed 484 people in Taganga, through a cluster sampling. It was applied the validated instrument, internationally and nationally, through Cronbach's alpha and Kuder-Richardson formula 20. Spearman's correlation was applied. In results, statistically significant correlation was observed between political action on climate change and risk perception index; and also between the index will to act and indices of risk perception, knowledge about the health effects due to climate change and political action on climate change. This study concludes that was observed an association between the index of willingness to act and risk perception, knowledge about the health effects of climate change and political action on climate change; also an association between political action on climate change and risk perception.