TA Group Research Articles

Effect of Structured Pre-anesthetic Communication on Preoperative Patient Anxiety

Background: The preanesthetic visit influences patient satisfaction and medical outcome. Providing relevant information may reduce anxiety. This study aimed to evaluate whether training for a structured interview technique improves communication skills, resulting in increased patient satisfaction and reduced patient’s anxiety and fear of anesthesia. Methods: Randomized controlled observational study, comparing patients (n=47) interviewed by anesthesiologists having obtained training to optimize structured communication (TA) or by anesthesiologists without such training (CA). Patient anxiety and fear was recorded before and after the preoperative interview. Interview duration and satisfaction with the anesthesiologist were also recorded. Data were analysed to test for superiority of the structured interview approach. Results: Mean preoperative anxiety was 1.2 VAS points lower in TA vs. CA group (95% CI-2.39; -0.03, P=0.082). Structured interviews significantly reduced preoperative anxiety in younger (<47 years) but not in older patients (≥ 47 years; interaction P=0.045). Patients’ fear of anesthesia was strongly reduced after the interview (median VAS: 8.0); reduction was stronger in the group with structured interview technique versus control group (difference in VAS: 1.86 [0.59; 3.12], P=0.006). Duration of the interview was statistically not significantly shorter using structured interview technique (P=0.142). Conclusion and recommendation: Compared to standard interview techniques, a structured interview approach reduces anxiety and fear of anesthesia, particularly in younger patients. Our data suggest that a structured interview technique may decrease the duration of the preoperative interview. Anesthesia departments should train communication skills geared toward a structured preoperative interview.

A Clinical Multicenter Randomized Controlled Study on JianpiQinghua Decoction in Treating Stage 3 Chronic Kidney Disease with A Syndrome Type of Dampness-heat due to Spleen Deficiency.

Objective To evaluate the clinical effectiveness of JianpiQinghua decoction in treating stage 3 chronic kidney disease (CKD3) with syndrome type of dampness-heat due to spleen deficiency. Methods A multicenter, randomized, controlled, prospective, double-blind, and double-simulation study was undertaken. A total of 270 CKD3 patients with syndrome type of dampness-heat due to spleen deficiency from the outpatient departments of six general hospitals were randomly divided into telmisartan+analog traditional Chinese medicine (TA) group, traditional Chinese medicine+analog telmisartan (TCMA) group, and telmisartan+traditional Chinese medicine (TTCM) group, in which the corresponding treatment was applied in addition to basic treatment. Six months later, changes in the traditional Chinese medicine (TCM) clinical symptom scores and renal functions before and after treatment were compared among these three groups. Results Of these 270 CKD3 patients who had been enrolled in this study, 30 cases lost to follow-up. The baseline data were comparable among these three groups. After treatment, the TCM clinical symptom scores of both syndrome of spleen-qi deficiency and dampness-heat in TA group were significantly higher than those in TCMA group and TTCM group (P<0.001). With the treatment time prolonged, the TCM clinical symptom scores showed similar descending trends in TCMA group and TTCM group but were different from that in TA group. After treatment, abnormal creatinine rate decreased (P=0.003), and these three treatments and their interactions with each visit had no effect on serum urea nitrogen value (P=0.270, P=0.520); with prolonged treatment, the estimated glomerular filtration rates in three groups tended to be relatively stable after the first rise. The liver function and abnormal serum potassium rate were not statistically significant before and after treatment (P>0.05). Conclusions JianpiQinghua decoction can improve clinical symptoms of TCM in CKD3 patients with syndrome type of dampness-heat due to spleen deficiency and thus improve the quality of life and prognosis. The clinical efficacy of JianpiQinghua decoction alone or combined with telmisartan is superior to telmisartan monotherapy.

Evaluation of a pharmacogenetic-based warfarin dosing algorithm in patients with low time in therapeutic range - study protocol for a randomized controlled trial.

BackgroundTime in therapeutic range (TTR) is a measurement of quality of warfarin therapy and lower TTR values (<50%) are associated with greater risk of thromboembolic and bleeding events. Recently, we developed a pharmacogenetic-based warfarin dosing algorithm specifically calibrated for a Brazilian patient sample. The aims of this study are: to evaluate the impact of a genetic-based algorithm, compared to traditional anticoagulation, in the time to achieve the therapeutic target and in TTR percentage; and to assess the cost-effectiveness of genotype-guided warfarin dosing in a specific cohort of patients with low TTR (<50%) from a tertiary cardiovascular hospital.Methods/designThis study is a randomized controlled trial in patients (n = 300) with atrial fibrillation with TTR < 50%, based on the last three INR values. At the first consultation, patients will be randomized into two groups: TA group (traditional anticoagulation) and PA group (pharmacogenetic anticoagulation). For the first group, the physician will adjust the dose according to current INR value and, for the second group, a pharmacogenetic algorithm will be used. At the second, third, fourth and fifth consultations (with an interval of 7 days each) INR will be measured and, if necessary, the dose will be adjusted based on guidelines. Afterwards, patients who are INR stable will begin measuring their INR in 30 day intervals; if the patient’s INR is not stable, the patient will return in 7 days for a new measurement of the INR. Outcomes measures will include the time to achieve the therapeutic target and the percentage of TTR at 4 and 12 weeks. In addition, as a secondary end-point, pharmacoeconomic analysis will be carried out. Ethical approval was granted by the Ethics Committee for Medical Research on Human Beings of the Clinical Hospital of the University of São Paulo Medical School.DiscussionThis randomized study will include patients with low TTR and it will evaluate whether a population-specific genetic algorithm might be more effective than traditional anticoagulation for a selected group of poorly anticoagulated patients.Trial registrationClinicalTrials.gov, NCT02592980. Registered on 29 October 2015.

Effects of nano tantalum implants on inducing osteoblast proliferation and differentiation.

In the present study, we examined the effects of nano tantalum (Ta) dental implants on inducing osteoblast proliferation and differentiation. The MG-63 osteoblasts were divided into 3 groups after recovery, passage and storage: i) Osteoblast culturing group (control group); ii) osteoblast and titanium (Ti) implant co-culturing group (Ti group); and iii) osteoblast and Ta implant co-culturing group (Ta group). After 7 days, a scanning electron microscope was used to observe the growth status, number and morphological changes of the cells on the surfaces of the materials. An MTT assay was used to detect cell proliferation after culturing for 1, 3 and 7 days. ELISA assay was used to detect the levels of alkaline phosphatase (ALP) after 1, 3 and 7 days. Western blot analysis was used to detect the expression levels of collagen type I (Col-1) and osteocalcin after 1, 3 and 7 days. There was significant cell spreading on the surfaces of Ti and of Ta after 7 days, flat and with many pseudopodia. Additionally, there were more cell components in the Ta group. Concurrently, cell proliferation in the Ti and Ta groups increased. There was also an increase in the level of ALP and the expression level of Col-1 over time. The indexes of the Ta group were more apparent than those of the Ti group at each time-point, and the differences were statistically significant (p<0.05). In conclusion, compared with Ti implants, Ta implants induced more osteoblast proliferation and differentiation.

Importance of additional temporary pin fixation combined coracoclavicular augmentation using a suture button device for acute acromioclavicular joint dislocation.

We evaluated the outcomes of coracoclavicular (CC) augmentation using a suture button device with additional temporary pin fixation for acute acromioclavicular (AC) joint dislocation. Thirty-six consecutive cases who underwent CC augmentation using TightRope™ (Arthrex, Naples, FL, USA) were included. We temporarily fixed trans-articular pins in the first 10 cases (TA group) and a trans-spine pin in the next 26 cases (TS group). The radiological and clinical outcomes were evaluated at minimum 2years postoperatively. The mean follow-up period was 56.7months (range, 24-84months). At the final follow-up evaluation, reduction status showed anatomical reduction in 25 cases (69.4%), slight loss of reduction in seven cases (19.4%), partial loss of reduction in two cases (5.6%), and total loss of reduction in two cases (5.6%). The mean ASES score, UCLA score, and subjective shoulder value were 92.3, 32.9, and 91.6%, respectively. There were no significant differences between the two groups with respect to the outcomes. Intraoperative complications occurred in three cases (8.3%) including two cases of failed reduction and one case of technical failure of the implant. Postoperative complications occurred in three cases (8.3%) including one case of pin tract infection and distal clavicle fracture at the clavicle-hole, one case of reduction loss by severe subsidence of the clavicular button, and one case of shoulder stiffness. CC augmentation using a suture button device with temporary pin fixation yielded satisfactory radiological and clinical outcomes. These results support that temporary pin fixation for the AC joint may help to protect the AC reduction in the early phase of healing and rigid scar formation when performing CC fixation using a suture button device. Level-IV, Retrospective Case Series, Treatment Study.

Mathematics-related emotions among Finnish adolescents across different performance levels

This study examined the relation of mathematics performance and gender with seven mathematics-related emotions (enjoyment, pride, anger, anxiety, shame, hopelessness and boredom) among adolescents. Using strict and lenient mathematics performance cut-off scores, respective groups of adolescents with mathematics difficulties (MD, n = 136), low (LA, n = 166) and typical mathematics performance (TA, n = 1056) were identified. Our results revealed that the MD group reported more shame than the LA group. The MD group also reported more negative emotions and less positive emotions than the TA group, with the exception of boredom, for which there was no statistically significant difference. The interaction effect between mathematics performance group and gender on emotions was significant. Only females with MD showed significantly higher levels of hopelessness and shame than females with LA, while males with LA even reported more boredom than males with MD. Concerning gender differences, males reported slightly more pride and enjoyment than females. However, the direction and magnitude of the gender differences showed great variance among mathematics performance groups. The practical implications of the results are discussed.

Immunomodulation in Middle-Aged Humans Via the Ingestion of Physta® Standardized Root Water Extract of Eurycoma longifolia Jack--A Randomized, Double-Blind, Placebo-Controlled, Parallel Study.

This study was aimed to investigate the capacity of a standardized root water extract of Eurycoma longifolia (Tongkat Ali, TA), Physta® to modulate human immunity in a middle-aged Japanese population. This randomized, double-blind, placebo-controlled, parallel study was conducted for 4 weeks. Eighty-four of 126 subjects had relatively lower scores according to Scoring of Immunological Vigor (SIV) screening. Subjects were instructed to ingest either 200 mg/day of TA or rice powder as a placebo for 4 weeks [TA and Placebo (P) groups] and to visit a clinic in Tokyo twice (weeks 0 and 4). SIV, immunological grade, immunological age, and other immune parameters were measured. Eighty-three subjects completed the study; 40 in the TA group and 41 in the P group were statistically analyzed, whereas two were excluded from the analyses. At week 4, the SIV and immunological grade were significantly higher in the TA group than those in P group (p < 0.05). The numbers of total, naïve, and CD4(+) T cells were also higher in the TA group than those in P group (p < 0.05). No severe adverse events were observed. The results suggest that ingestion of the root water extract of TA (Physta®) enhances comprehensive immunity in both middle-aged men and women. This study is registered in UMIN-CTR (UMIN000011753).

Allopurinol Resistance in Leishmania infantum from Dogs with Disease Relapse.

BackgroundVisceral leishmaniasis caused by the protozoan Leishmania infantum is a zoonotic, life threatening parasitic disease. Domestic dogs are the main peridomestic reservoir, and allopurinol is the most frequently used drug for the control of infection, alone or in combination with other drugs. Resistance of Leishmania strains from dogs to allopurinol has not been described before in clinical studies.Methodology/Principal FindingsFollowing our observation of clinical disease relapse in dogs under allopurinol treatment, we tested susceptibility to allopurinol of L. infantum isolated from groups of dogs pre-treatment, treated in remission, and with disease relapse during treatment. Promastigote isolates obtained from four treated relapsed dogs (TR group) showed an average half maximal inhibitory concentration (IC50) of 996 μg/mL. A significantly lower IC50 (P = 0.01) was found for isolates from ten dogs before treatment (NT group, 200 μg/mL), as well as for five isolates obtained from treated dogs in remission (TA group, 268 μg/mL). Axenic amastigotes produced from isolates of the TR group also showed significantly higher (P = 0.002) IC50 compared to the NT group (1678 and 671 μg/mL, respectively). The lower sensitivity of intracellular amastigotes from the TR group relative to those from the NT group (P = 0.002) was confirmed using an infected macrophage model (6.3% and 20% growth inhibition, respectively at 300 μg/mL allopurinol).ConclusionsThis is the first study to demonstrate allopurinol resistance in L. infantum and to associate it with disease relapse in the canine host. These findings are of concern as allopurinol is the main drug used for long term control of the disease in dogs, and resistant L. infantum strains may enhance uncontrolled transmission to humans and to other dogs.

Abstract 17539: Conventional vs. Transcatheter Aortic Valve Replacement - Propensity Score Adjusted Comparison of 3,751 Unselected Patients

Background and Hypothesis: Transcatheter aortic valve replacement (TAVR) is an established method in high-risk patients. Two aspects of this procedure are currently under discussion: 1.) Do the data acquired from randomized studies and registers justify expansion of the procedure to include younger and healthier patients? 2.) Is the transfemoral approach superior to the transapical approach with regard to mortality and periprocedural complications? Against this background we examined the mortality and morbidity of all patients who received an isolated conventional, transapical or transfemoral aortic valve replacement in accordance with the criteria of the Valve Academic Research Consortium (VARC)-2. Methods: A prospective register was taken from a single center recording all conventional (CONV, n=2,881), transapical (TAVR-TA, n=363) and transfemoral (TAVR-TF, n=570) aortic valve implantations during the period from 07/2009 to 10/2014. Using propensity score (PS) matching, first CONV and TAVRall (TA+TF) and then TAVR-TA and TAVR-TF were paired on the basis of 21 risk variables, creating comparable groups. Results: 393 pairs CONV vs. TAVRall within a moderate risk could be created (EuroSCORE 18.7 vs. 18.5; STS 5.0 vs. 5.4). Comparison revealed no difference for 30d mortality (4.6% CONV vs. 5.1% TAVRall, p=0.74), stroke (2.8% vs. 2.0%, p=0.48) or myocardial infarction (0.0 vs. 0.3%, p=0.50). Bleeding complications were significantly more frequent in the CONV, SM implantations and vascular complications in the TAVRall group. In the PS-adjusted comparison TAVR-TA vs. TAVR-TF (289 pairs; EuroSCORE 25.1 vs. 22.1; STS 6.8 vs. 6.7) there was also no difference in the hard endpoints (30d mortality 4.9% TA vs. 4.2% TF, p=0.70; stroke 3.1% vs. 2.8%, p=0.81; myocardial infarction 0.4% vs. 0.4%, p=1.00). Here bleeding complications were significantly more frequent in the TA group, SM implantations and vascular complications in the TF group. Subgroup analyses show an advantage of the TAVR procedure in patients with high STS or low LVEF. Conclusions: These data show that 1.) conventional aortic valve replacement and TAVR are comparable in the moderate risk group, and 2.) the two approaches, transapical and transfemoral, produce comparable results.

Efectos de la acupuntura sobre la fatiga inducida por ejercicios físicos exhaustivos: una investigación metabolómica

In this study, the antifatigue effects of acupuncture had been investigated at the metabolic level on the young male athletes with exhaustive physical exercises. After a series of exhaustive physical exercises and a short-term rest, the athletes either were treated with needling acupuncture on selected acupoints (TA group) or enjoyed an extended rest (TR group). NMR-based metabolomics analysis was then applied to depict the metabolic profiles of urine samples, which were collected from the athletes at three time points including the time before exercises, the time before and after the treatment of acupuncture, or taking the extended rest. The results from multivariate statistical analysis indicated that the recoveries of disturbed metabolites in the athletes treated with acupuncture were significantly faster than in those only taking rest. After the treatment with acupuncture, the levels of distinguished metabolites, 2-hydroxybutyrate, 3-hydroxyisovalerate, lactate, pyruvate, citrate, dimethylglycine, choline, glycine, hippurate, and hypoxanthine were recovered at an accelerated speed in the TA group in comparison with the TR group. The above-mentioned results indicated that the acupuncture treatment ameliorated fatigue by backregulating the perturbed energy metabolism, choline metabolism, and attenuating the ROS-induced stress at an accelerated speed, which demonstrated that acupuncture could serve as an alternative fatigue-relieving approach.

Electronic, Thermal, and Superconducting Properties of Metal Nitrides (MN) and Metal Carbides (MC) (M=V, Nb, Ta) Compounds by First Principles Studies

AbstractStructural, electronic, and superconducting properties of carbides and nitrides of vanadium (V), niobium (Nb), and tantalum (Ta) (group V transition elements) have been studied by computing their electronic band structure characteristics. The electronic band structure calculations have been carried out based on the density functional theory (DFT) within the local density approximation (LDA) by using the tight binding linear muffin tin orbital method. The NaCl-type cubic structures of MN and MC (M=V, Nb, Ta) compounds have been confirmed from the electronic total energy minimum of these compounds. The ground state properties, such as equilibrium lattice constant (a0), bulk modulus (B), and Wigner–Seitz radius (S0) are determined and compared with available data. The electronic density of states reveals the metallic nature of the chosen materials. The electronic specific heat coefficient, Debye temperature, and superconducting transition temperature obtained from the band structure results are found to agree well with the earlier reported literature.

Blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass

Objective To evaluate the blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass(CPB). Methods A total of 56 children of both sexes, aged 11 months-14 yr, with body mass index of 9.8-21.4 kg/m2, of ASA physical statusⅡ or Ⅲ, with left ventricular ejection fraction >50%, scheduled for elective radical correction of tetralogy of Fallot with CPB, were randomly divided into 2 groups using a random number table: tranexamic acid group(TA group, n=30)and normal saline group(NS group, n=26). Anesthesia was induced with iv midazolam, sufentanil, vecuronium and propofol.The children were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 1%-2% sevoflurane and infusion of propofol, sufentanil and vecuronium.After induction of anesthesia, a loading dose of tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision, followed by infusion at a rate of 10 mg·kg-1·h-1 until the end of surgery in TA group, while the equal volume of normal saline was given instead in NS group.The volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells, fresh frozen plasma, platelet and cryoprecipitate transfused were recorded.The requirement for re-thoracotomy for bleeding, and the incidence of hepatic artery and portal vein thrombosis were also recorded. Results Compared to NS group, the volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells, fresh frozen plasma, platelet and cryoprecipitate transfused were significantly reduced in TA group.No re-thoracotomy was required in TA group, and the rate of re-thoracotomy was 15% in NS group.No hepatic artery and portal vein thrombosis were detected in group TA. Conclusion Tranexamic acid(loading dose 10 mg/kg, maintenance dose 10 mg·kg-1·h-1)can provide blood-saving effect and has high security in pediatric patients undergoing radical correction of tetralogy of Fallot with CPB. Key words: Tranexamic acid; Tetralogy of Fallot; Cardiopulmonary bypass; Child

Association Between Distal Hyperplastic Polyps and Proximal Neoplastic Lesions: A Prospective Study Among 5,613 Subjects

We evaluated the association between distal neoplasia and synchronous proximal neoplasia among asymptomatic subjects in a colorectal cancer screening programme, as current evidence on this association is inconclusive. We recruited Chinese asymptomatic screening participants aged 50-70 years who underwent colonoscopy in Hong Kong from 2008-2014. 206 subjects with distal advanced neoplasia or cancer were excluded. The association between distal pathology (tubular adenoma [TA]; hyperplastic polyps [HPs]; no polyps) and proximal pathology (proximal neoplasia [PN]; proximal advanced neoplasia [PAN]) was assessed by multivariate regression models – overall and stratified by the Asia Pacific Colorectal Screening (APCS) scoring system (score 4-7: high-risk; 0-3: lower-risk). A total of 5,842 screening participants underwent colonoscopy. We excluded 206 subjects who were found to have distal advanced neoplasia or distal cancer, and 23 subjects who were intolerant to the laxative regimen or whose bowel preparation was poor. Their average age was 57.6 years (SD 4.87). The prevalence of PN in the “no distal polyp” group, “distal HP” group and “distal TA” group was 14.8%, 19.3% and 29.4%, respectively. The corresponding prevalence of PAN was 1.8%, 3.2% and 3.5%. Participants with distal HPs did not have significantly higher odds of PN (adjusted odds ratio [AOR]=1.24, 95% C.I. 0.97-1.59, P = .089) or PAN (AOR=1.77, 95% C.I. 1.00-3.13, P = .052), except in lower-risk subjects where the odds of PAN was marginally higher in the “distal HP” group than the “no distal polyp” group (AOR=1.97, 95% C.I. 1.01-3.85, P = .048). Overall, the “distal polyp” group had significantly lower odds of PN than the distal TA group (AOR=0.55, 95% C.I. 0.40-0.76, P < .001). The increased risk of PN and PAN among those with distal HPs was modest. Recommending colonoscopy for every patient with distal HPs detected by screening sigmoidoscopy is not supported by the present findings.

1:27 PM, Abstract No. 269 - Safety and efficacy of renal cryoablation for small renal masses: midterm follow-up

database, all patients with stage T1aN0M0 RCC (r4cm) diagnosed in 2004 to 2011 were identified. Sociodemographic trends in use of surgery vs. TA were evaluated by chi-square and logistic regression. Overall survival (OS) was estimated using Kaplan-Meier from the time of diagnosis. Difference in utilization rate of TA in 2004-2007 vs. 2008-2011 was observed. Results: Of 28351 patients with T1a lesion, 2133 (7.5%) did not receive curative therapy. Of 26218 patients who received curative therapy, the majority underwent surgical resection: 24992 (95.3%) surgical resection, 671(2.6%) CRA, 553(2.1%) (po0.001). While mean overall survival was similar between the surgery (81.1 months) and TA (81.0 months) group (p1⁄40.612). Those who did not receive curative therapy had a significantly shorter mean OS (70.4 mo; po0.001) when compared to curative group as a whole. Furthermore, mean OS for TA group was also significantly prolonged compared to no curative therapy group (po0.001). Being unmarried, Z65 years of age, being insured, living in metropolitan areas, in Pacific Coast region, and residing in areas with higher median family income demonstrated higher likelihoods of receiving TA when compared to surgery (po0.001). There was a significant increase in the rate of use of TA compared to surgery in more recent years (3.2% in 2004-2007 vs. 5.3% in 2008-2011 (po0.001)). Older age, being unmarried, living in rural areas with lower median family income and lower educational status were found to be predictor of not receiving therapy. Conclusion: There was significant disparity in the management of T1a RCC lesions, in part affected by patient’s sociodemographic determinants. In addition, there was significant underutilization of less invasive thermal ablation which demonstrated similar survivorship compared to surgery and significantly prolonged survival compared to no therapy.

교통사고 환자의 MMPI 및 통증, 영상평가에 대한 임상연구

This study analyzed the MMPI (Minnesota Multiphashic Personality Inventory), VAS (Visual Analogue Scale), cervical and lumbar curvature (Cervical angle, Ishihara Index, Lumbar angle, Ferguson angle) and satisfaction score of patient of traffic accident. About 59 cases of patients admitted to the Korean Medicine hospital, MMPI and pain levels (VAS) cervical and lumbar curvature (Cervical angle, Ishihara Index, lumbar angle, Ferguson angle) and satisfaction score were measured and statistically analyzed. Depending on the type of accident divided into two groups of In car TA and Out car TA. After hospitalization, patient's pain index was improved as a whole. Pain index and evaluation of the cervical and lumbar curvature, according to the accident types, the difference was not statistically significant. In the analysis of the MMPI validity scales, In car TA group was analyzed by 'V-shaped', Out car TA group was analyzed by umbrella- shaped, 'inverted V-shaped'. Clinical scales of out car TA group were analyzed by 3-1 profile compared to the In car TA group. Results of multiple regression analysis showed no association between factors and MMPI scales. In the case of a traffic accident patients, damage to the body, as well as emotional and psychological factors are thought to affect the condition or prognosis of patients. In the future, for the management and treatment of these parts will be needed to complement the academic or institutional.

The Intervention Effects of Acupuncture on Fatigue Induced by Exhaustive Physical Exercises: A Metabolomics Investigation.

In this study, the antifatigue effects of acupuncture had been investigated at the metabolic level on the young male athletes with exhaustive physical exercises. After a series of exhaustive physical exercises and a short-term rest, the athletes either were treated with needling acupuncture on selected acupoints (TA group) or enjoyed an extended rest (TR group). NMR-based metabolomics analysis was then applied to depict the metabolic profiles of urine samples, which were collected from the athletes at three time points including the time before exercises, the time before and after the treatment of acupuncture, or taking the extended rest. The results from multivariate statistical analysis indicated that the recoveries of disturbed metabolites in the athletes treated with acupuncture were significantly faster than in those only taking rest. After the treatment with acupuncture, the levels of distinguished metabolites, 2-hydroxybutyrate, 3-hydroxyisovalerate, lactate, pyruvate, citrate, dimethylglycine, choline, glycine, hippurate, and hypoxanthine were recovered at an accelerated speed in the TA group in comparison with the TR group. The above-mentioned results indicated that the acupuncture treatment ameliorated fatigue by backregulating the perturbed energy metabolism, choline metabolism, and attenuating the ROS-induced stress at an accelerated speed, which demonstrated that acupuncture could serve as an alternative fatigue-relieving approach.

Angiomas en penacho en la infancia. Serie de 9 casos y revisión de la literatura

IntroductionTufted angioma (TA) is a rare benign vascular tumor that mostly appears during infancy or early childhood, although there are cases reported in adults. Clinical presentation and evolution of TA can vary. Histologically, it takes on a classic appearance of vascular tufts (“cannon ball” like appearance). Patients and methodsA retrospective observational study was conducted that included all patients diagnosed with TA at our center in the last 20 years. ResultsA series of 9 cases of tufted angioma in childhood are presented, 77.7% of which were congenital. This represents a frequency higher than previously described. Spontaneous regression was observed in 55.5% of the cases, and was more frequent in the congenital TA group. Unlike other TA series reported in the literature, a higher proportion of patients with spontaneous regression was observed in this series, with a higher prevalence in females (6 out of 9 children) and predominantly located in the upper limbs. None of our patients had Kasabach-Merritt phenomenon. ConclusionsThere are many ways of treating TA, but none are uniformly effective. Given the high rate of spontaneous regression in congenital or early TA, we suggest that, in the absence of other complications, monitoring would be a good option for management.

309P - Does Administration Order of Sequential Fec- Docetaxel As Adjuvant Chemotherapy for Breast Cancer Affect on the Toxicities? : a Retrospective Analysis from a Single-Center

ABSTRACT Aim: Anthracyclines and taxanes based regimens have been established as one of standard adjuvant chemotherapy for early breast cancer. For the high-risk patients, sequential rather than the concomitant use of both agents should be considered.Conventionally, Anthracyclines followed by taxanes (AT) are preferred. However, some recent trials reported that preceding taxanes had equivalent efficacy. Since each has different toxic profile, it is important to compare AT with TA in terms of toxicity and relative dose intensity (RDI). The purpose of this retrospective study was to assess the influence of administration order. Methods: We analyzed 88 patients with early breast cancer who were treated with each 4 cycles of FEC (5-fluorouracil, epirubicin and cyclophosphamide) and Doc (docetaxel) as adjuvant chemotherapy. Consecutive 46 and 42 patients received FEC → Doc (AT group) From January to December of 2012 and Doc → FEC (TA group) for the same period of 2013, respectively. The data was collected from medical records, and toxicities were evaluated by CTCAE criteria. Statistical analysis was performed using Fisher's exact test. Results: There was no significant bias in patients' characteristics between both groups. Although the hematological toxicities seen in FEC and Doc phase were equal in both group, schedule delay of FEC were found more frequent in TA (19.0%) than AT (8.6%) because of insufficient recovery of neutropenia (p Conclusions: The administration of Doc before FEC results in reduced HFS by Doc, but RDI of FEC tends to decrease because of altered hematological toxicity. Evaluation of the prospective study is desired. Disclosure: All authors have declared no conflicts of interest.

The dynamic separation of pallidal neurons into anti-phase oscillatory groups under Parkinsonian conditions in a computational model

Neurons in the globus pallidus (GP) of urethane anesthetized rats typically display one of four spiking patterns: tonic, non-modulated, firing (the NM group); firing that occurs preferentially during either the active or inactive phases of slow cortical oscillations (TA or TI group, respectively); or silence/quiescence (QU group). In healthy animals the vast majority of neurons are in the non-modulated group. However, under conditions of experimentally-induced Parkinsonism there is a dramatic increase in the number of neurons whose firing patterns show modulation by the slow cortical rhythm, either in-phase or anti-phase [1]. The mechanism that underlies the increased tendency for GP neurons to become entrained by cortical rhythms is unclear, but it may contribute to some of the motor symptoms of Parkinson’s disease. There are two main pathways from the cortex to the GP: via the inhibitory striatum and via the excitatory subthalamic nucleus (STN), but it is not known how these inputs sculpt the pathological pallidal firing patterns. To study this we developed a neural network model of single compartment conductance-based (Hodgkin-Huxley) pallidal neurons, based on a previous multi-compartment model [2]. The GP neurons received rhythmic input from STN neurons and reciprocal inhibition from each other. Under “healthy” conditions, almost all model GP neurons showed tonic firing that was not significantly modulated by the rhythmic STN input (Figure 1A,B). We attempted to model “Parkinsonian” conditions by increasing the intensity of STN neuron firing and the strength of STN-GP and GP-GP synapses. Under these conditions, two groups of anti-phase oscillatory GP neurons emerged (Figure 1C,D). Our model also includes downregulation of Hyperpolarization activated Cyclic Nucleotide-gated (HCN) channels in response to bursting, since this may contribute to emergence of Parkinsonian activity [3]. We found that this provides better agreement with experimental data but that it is not essential in order for the two groups to appear. Figure 1 Proportions of neurons in each category (A,C) and spiking activity sorted by classification confidence (B,D) for healthy (left) and Parkinsonian (right) parameters. Our results [4] support the hypothesis that oscillatory entrainment occurs primarily via the subthalamic pathway. We find that as a result of the interplay between excitatory input from the STN and mutual inhibition between GP neurons, the network shows a self-organizing dynamical behavior where two groups of neurons (TI and TA) emerge out of a homogeneous population.

Comparison of Gemcitabine Combined With Targeted Agent Therapy Versus Gemcitabine Monotherapy in the Management of Advanced Pancreatic Cancer

PurposeTargeted therapy has brought great clinical benefits for patients with multiple solid tumors, but its effects in patients with locally advanced/metastatic pancreatic cancer (LA/MPC) are disputed. This systematic evaluation compared the efficacy and safety profiles of gemcitabine combined with targeted agents (GEM + TA) versus gemcitabine administered as monotherapy or combined with placebo (GEM ± PLC) in LA/MPC patients. MethodsPubMed and EMBASE were searched for relevant randomized controlled trials published on or before April 30, 2013. The primary end points were overall survival (OS) and progression-free survival (PFS); the secondary end points were 1-year survival rate, objective response rate (ORR), and toxicity rates (TRs), defined as the prevalence of grade 3/4 adverse events. The systematic evaluation was performed by using Review Manager version 5.1.7. FindingsA total of 10 randomized controlled trials involving 3899 patients (2195 males; mean age, 63.6 years) were included in the systematic evaluation. The results reported that there was no significant difference in OS (hazard ratio [HR] = 0.97 [P = 0.85]), PFS (HR = 0.95 [P = 0.14]), or ORR (odds ratio [OR] = 0.95 [P = 0.69]) between GEM + TA and GEM ± PLC. However, a marginal difference in 1-year survival rate (OR = 0.80 [P = 0.05]) between the 2 groups was observed. The grade 3/4 TRs of anemia, diarrhea, nausea, neutropenia, thrombocytopenia, and vomiting were not significantly different between the 2 groups. However, the prevalence of grade 3/4 rash was significantly greater in the GEM + TA group (OR = 8.31 [P < 0.01]). ImplicationsBased on the results from this analysis, the addition of targeted agents to a regimen of gemcitabine treatment does not bring survival benefits except 1-year survival rate to patients with LA/MPC.