Cost effectiveness of personalized treatment in women with early breast cancer: the application of OncotypeDX and Adjuvant! Online to guide adjuvant chemotherapy in Austria

A Breast Cancer Outcomes model was developed at the ONCOTYROL research center to evaluate personalized test-treatment strategies in Austria. The goal was to evaluate the cost-effectiveness of a new 21-gene assay (ODX) when used in conjunction with the Adjuvant! Online (AO) decision aid to support personalized decisions about use of adjuvant chemotherapy in early-stage breast cancer patients in Austria. We applied a validated discrete-event-simulation model to a hypothetical cohort of 50 years old women over a lifetime horizon. The test-treatment strategies of interest were defined using three-letter acronyms. The first (second, third) letter indicates whether patients with a low (intermediate, high) risk according to AO were tested using ODX (Y yes, N no). The main outcomes were life-years gained, quality-adjusted life-years (QALYs), costs and cost effectiveness. Robustness of the results was tested in sensitivity analyses. Results were compared to a Canadian analysis conducted by the Toronto Health Economics and Technology Assessment Collaborative (THETA). Five of eight strategies were dominated (i.e., more costly and less effective: NNY, NYN, YNN, YNY, YYN). The base-case analysis shows that YYY (ODX provided to all patients) is the most effective strategy and is cost effective with an incremental cost-effectiveness ratio of 15,700 EUR per QALY gained. These results are sensitive to changes in the probabilities of distant recurrence, age and costs of chemotherapy. The results of the base-case analysis were comparable to the THETA results. Based on our analyses, using ODX in addition to AO is effective and cost effective in all women in Austria. The development of future genetic tests may require alternative or additional test-treatment strategies to be evaluated.

from #Medicine via ola Kala on Inoreader http://ift.tt/1NZJWEq
via IFTTT

Symptomatic small schwannoma is a risk factor for surgical complications and correlates with difficulty of enucleation

Postoperative neurological deficits of schwannomas are the complications that we want to avoid most. Predicting postoperative neurological deficits is crucial; however, the correlation between preoperative symptoms and neurological findings with postoperative neurological complications has not yet been completely clarified. Here we analyzed the risk factors for postoperative neurological complications. The study included 131 tumors from 107 patients histologically confirmed as schwannomas, which developed in the extremities and trunk without spinal cord involvement. The correlation between clinical findings and postoperative complications were statistically analyzed. One-hundred three tumors (78.6 %) had the preoperative neurological symptoms; these symptoms were detected in 93.3 % of small tumors (<4 cm 3 ). We defined it as follows about the anatomical location of schwannomas. One is "central type" that normal nerve bundles widely splayed over the tumor's capsule (tumor located in the central region of the nerve). Another is "peripheral type" that easy to enucleate without neurolysis (tumor located in the peripheral region of the nerve). Static analysis showed a significant difference in the Tinel sign, numbness, and postoperative neurological deficits (p = 0.04, 0.006, p < 0.001, respectively). Twenty-one cases (16.0 %) showed new postoperative neurological symptoms, including numbness in 12 cases, dysesthesia in three cases, pain in three cases, and slight motor palsy in two cases. In statistical analysis, small tumors (<4 cm 3 ) significantly correlated with Tinel sign (p < 0.001), and was marginally significant with postoperative neurological deficits (p = 0.05). Moreover, small tumors (<4 cm 3 ) accompanying numbness preoperatively significantly correlated with postoperative neurological deficits (p = 0.04). Small (<4 cm 3 ) tumors significantly correlated with the preoperative neurological symptoms. Those tumors accompanying numbness also significantly correlated with the difficulty of the enucleation and postoperative neurological deficits. These findings will help to predict the neurological complication.

from #Medicine via ola Kala on Inoreader http://ift.tt/1QapPb3
via IFTTT

Lymphocyte subpopulations in myocardial infarction: a comparison between peripheral and intracoronary blood

The frequency and profile of lymphocyte subsets within the culprit coronary artery were investigated in 33 patients with myocardial infarction and compared to their systemic circulating counterparts. T cell subsets including CD4 + CD28null, activated and regulatory T-cells, TH1/TH2/TH17 phenotypes, NK and B-cells were studied in intracoronary (IC) and arterial peripheral blood (PB) samples. CD4 + CD28null T-lymphocytes were significantly increased in IC compared to PB (3.7 vs. 2.9 %, p < 0.0001). Moreover, patients with more than 6 h of evolution of STEMI exhibited higher levels of CD4 + CD28null T-cells suggesting that this subset may be associated with more intense myocardial damage. The rare NK subpopulation CD3 − CD16 + CD56 − was also increased in IC samples (5.6 vs. 3.9 %, p = 0.006). CD4 + CD28null T-cells and CD3 − CD16 + CD56 − NK subpopulations were also associated with higher CK levels. Additionally, IFN-γ and IL10 were significantly higher in IC CD4 + lymphocytes. Particular immune cell populations with a pro-inflammatory profile at the site of onset were increased relative to their circulating counterparts suggesting a pathophysiological role of these cells in plaque instability, thrombi and myocardial damage.

from #Medicine via ola Kala on Inoreader http://ift.tt/1QapPaT
via IFTTT

The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis

Background: There is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact. Methods: We retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period. We analysed all surgical admissions with respect to patient demographics (age and gender), diagnosis, and procedure performed. Results: Surgical admissions accounted for 12.9 and 19.8 % of all hospital admissions in Malawi and Sierra Leone respectively. 18.5 and 6.2 % of all hospital patients required a surgical procedure in Malawi and Sierra Leone respectively, with the low number in Sierra Leone accounted for in that many of the obstetric admissions were referred to a nearby Medicins Sans Frontiers (MSF) hospital for treatment. 17.9 and 10.5 % of surgical admissions were under the age of 16 in Malawi and Sierra Leone respectively, with 16–35 year olds accounting for 57.3 % of surgical admissions in Sierra Leone and 53.5 % in Malawi. Men accounted for 53.7 and 46.0 % of surgical admissions in Sierra Leone and Malawi respectively. An unexpected finding was the high level of patients who absconded from hospital in Sierra Leone after diagnosis but before treatment. This involved 11.8 % of all surgical patients, including 38 % with a bowel obstruction, 39 % with peritonitis and 20 % with ectopic pregnancy. Conclusions: Most people affected by disease requiring surgery are young adults and this may have significant economic implications.

from #Medicine via ola Kala on Inoreader http://ift.tt/1QapMfj
via IFTTT

How welcome do Iranian-Americans feel in their homeland? Perceptions of social distance among Muslim, Jewish, and Non-Religious Iranian-American adults

Recent political events in the United States have created a political climate that promotes prejudice against Middle Eastern, Iranian, and Muslim people. In this study, we were interested in investigating two questions: (1) How welcome do Iranian-American men and women from various religious backgrounds (Muslim, Jewish, or no religious affiliation) feel in their new homeland (specifically, how much social distance (affective distance) do they think their Euro-American neighbors feel toward them? and (2) to what extent does the possession of stereotypical Middle Eastern, Iranian, or Muslim traits (an accent, darker skin, wearing of religious symbols, traditional garb, etc.) spark prejudice and thus Iranian-Americans perception of social distance? Participants were recruited from two very different sources: (1) shoppers at grocery stores in Iranian-American neighborhoods in Los Angeles, and (2) a survey posted on http://Surveymonkey.com. A total of 374 Iranian-Americans, ages 18 and older, completed an in-person or online questionnaire that included the following: a request for demographic information, religious preferences, a survey of how typically Iranian-American the respondents' traits were, and the social distance scale. A surprise was that it was the Iranian-American Jews (not the Muslims), who felt most keenly that Euro-Americans kept them at a distance. Jewish women received higher scores on the social distance scale than did members of any other group. In addition, again, it was mainly Iranian-American Jews, particularly those who spoke with a Middle Eastern accent or wore stereotypically religious symbols, who felt the most social distance existing between them and "typical" Americans.

from #Medicine via ola Kala on Inoreader http://ift.tt/1QapOUr
via IFTTT

Multi technique amalgamation for enhanced information identification with content based image data

Image data has emerged as a resourceful foundation for information with proliferation of image capturing devices and social media. Diverse applications of images in areas including biomedicine, military, commerce, education have resulted in huge image repositories. Semantically analogous images can be fruitfully recognized by means of content based image identification. However, the success of the technique has been largely dependent on extraction of robust feature vectors from the image content. The paper has introduced three different techniques of content based feature extraction based on image binarization, image transform and morphological operator respectively. The techniques were tested with four public datasets namely, Wang Dataset, Oliva Torralba (OT Scene) Dataset, Corel Dataset and Caltech Dataset. The multi technique feature extraction process was further integrated for decision fusion of image identification to boost up the recognition rate. Classification result with the proposed technique has shown an average increase of 14.5 % in Precision compared to the existing techniques and the retrieval result with the introduced technique has shown an average increase of 6.54 % in Precision over state-of-the art techniques.

from #Medicine via ola Kala on Inoreader http://ift.tt/1NZJQMO
via IFTTT

Cloning and transcriptional expression of a novel gene during sex inversion of the rice field eel (Monopterus albus)

We performed annealing control primer (ACP)-based differential-display reverse transcription-polymerase chain reaction (DDRT-PCR) to isolate differentially expressed genes (DEGs) from the stage IV ovary and ovotestis of the rice field eel, Monopterus albus. Using 20 arbitrary ACP primers, 14 DEG expressed-sequence tags were identified and sequenced. The transcriptional expression of one DEG, G2, was significantly greater in the ovotestis than the stage IV ovary. To understand the role of G2 in sex inversion, G2 cDNA was cloned and semi-RT-PCR, real time PCR were performed during gonad development. The full-length G2 cDNA was 650 base pairs (bp) and it comprised a 5′-untranslated region (UTR) of 82 bp, a 3′-UTR of 121 bp and an open reading frame of 444 bp that encoded a 148-amino acid protein. The expression of G2 was weak during early ovarian development until the stage IV ovary, but expression increased significantly with gonad development. We speculate that G2 may play an important function during sex inversion and testis development in the rice field eel, but the full details of the function of this gene requires further research.

from #Medicine via ola Kala on Inoreader http://ift.tt/1QapLYF
via IFTTT